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The health status and medical services utilization of recent immigrants to Manitoba and British Columbia… Kliewer, Erich Victor, 1944-; Kazanjian, Arminée, 1947- Sep 30, 2000

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T H E  U N I V E R S I T Y  O F  B R I T I S H  C O L U M B I ACentre for Health Servicesand Policy ResearchThe Health Status and MedicalServices Utilization of RecentImmigrants to Manitoba andBritish Columbia: A Pilot StudyPrepared forCitizenship and Immigration CanadaBCOHTA 00:18J SEPTEMBER 2000Department ofPreventive Oncology& EpidemiologyManitoba HealthPublic Health BranchEpidemiology UnitThe Health Status and Medical ServicesUtilization of Recent Immigrants to Manitobaand British Columbia: A Pilot StudyErich KliewerEpidemiology Unit, Public Health BranchManitoba HealthandDepartment of Preventive Oncology and EpidemiologyCancerCare ManitobaArminée KazanjianCentre for Health Services and Policy ResearchandDepartment of Health Care and EpidemiologyThe University of British ColumbiaPrepared forCitizenship and Immigration CanadaSeptember 2000BC Office of Health Technology AssessmentCentre for Health Services and Policy ResearchUniversity of British Columbia429 - 2194 Health Sciences MallVancouver BC  (Canada)  V6T 1Z3Tel: (604) 822-7049Fax: (604) 822-7975bcohta@chspr.ubc.cawww.chspr.ubc.caPublication DataKliewer, Erich Victor,  1944-The health status and medical services utilization of recent immigrantsto Manitoba and British Columbia“BCOHTA 00:18J”ISBN 1-896256-18-X1. Immigrants—Health and hygiene—Manitoba.  2. Immigrants—Healthand hygiene—British Columbia.  3. Immigrants—Medical care—Manitoba.4. Immigrants—Medical care—British Columbia.    I. Kazanjian, Arminée,1947-   II. Canada. Citizenship and Immigration Canada.   III. BritishColumbia Office of Health Technology Assessment.   IV. Title.RA449.K54 2001 362.1’086’9109711 C00-911643-5© 2000 by British Columbia Office of Health Technology Assessment,The University of British ColumbiaPermission is granted to reproduce all or any portion of this report,providing  acknowledgement is given to the authorsiiiTable of ContentsAcknowledgements ................................................................................................... vExecutive Summary .................................................................................................. v1. Introduction ......................................................................................................... 12. Methods ........................................................................................................... 12.1 Data sources .................................................................................................... 12.1.1 Immigrant landing file .................................................................................. 12.1.2 British Columbia ................................................................................... 22.1.3 Manitoba ................................................................................................ 22.2 Record Linkage ............................................................................................... 22.2.1 Manitoba ................................................................................................ 22.2.2 British Columbia ................................................................................... 22.3 Arrival, landing and coverage dates ....................................................................... 32.4 Variable recoding ............................................................................................ 42.5 Analyses .......................................................................................................... 43. Results ........................................................................................................... 53.1 Record linkage ................................................................................................ 53.1.1 Landing year .......................................................................................... 53.1.2 Sex ......................................................................................................... 53.1.3 Age ........................................................................................................ 63.1.4 Marital status ......................................................................................... 63.1.5 Region of birth ....................................................................................... 73.1.6 Visa category ......................................................................................... 73.1.7 Medical profile assessment ........................................................................... 83.1.8 Conditions of landing .................................................................................. 83.2 Physician claims .............................................................................................. 93.2.1 Age ........................................................................................................ 93.2.2 Diagnosis ............................................................................................. 113.2.3 Visa category ....................................................................................... 133.2.4 Birthplace ............................................................................................ 143.2.5 Language ............................................................................................. 173.2.6 Medical profile assessment ......................................................................... 183.2.7 Conditions of landing ................................................................................. 193.2.8 Marital status ....................................................................................... 203.2.9 Education ............................................................................................. 213.2.10 Years of schooling .................................................................................. 22iv3.3 Hospital discharges ....................................................................................... 243.3.1 Age ...................................................................................................... 243.3.2 Diagnosis ............................................................................................. 253.3.3 Procedure ............................................................................................. 283.3.4 Visa category ....................................................................................... 283.3.5 Birthplace ............................................................................................ 323.3.6 Language ............................................................................................. 323.3.7 Medical assessment .................................................................................. 353.3.8 Conditions of landing ................................................................................. 363.3.9 Marital status ....................................................................................... 373.3.10 Education ........................................................................................... 383.3.11  Years of schooling .................................................................................. 403.4 Communicable diseases .................................................................................. 413.5 Cancer ........................................................................................................... 414.  Discussion and Conclusions .................................................................................. 43Appendices ........................................................................................................ 46Appendix I.  Variable re-coding ................................................................................ 46I.1 Visa category ............................................................................................. 46I.2 Country of birth ......................................................................................... 47I.3 Conditions of landing imposed ......................................................................... 48I.4 Medical profile assessment ............................................................................... 48I.5 Diagnoses ................................................................................................... 48I.6 Procedures .................................................................................................. 49vAcknowledgementsWe thank Stefan Lindemann of Citizenship and Immigration Canada for assistance withthe immigrant landing file. We would also like to thank Debbie Nowicki of theCommunicable Disease Control Unit of Manitoba Health for providing the informationfrom the communicable diseases database. We are grateful to André Wajda of theEpidemiology Unit of Manitoba Health and Patrick Wong Fung of the University ofBritish Columbia’s Centre for Health Services and Policy Research for undertaking therecord linkage. Without their record linkage skill this study would never have been ableto proceed. We are also indebted to Mr Wong Fung for extracting the required BritishColumbia data. Finally, we owe a big thank you to Errin Minish of the Department ofPreventive Oncology and Epidemiology of CancerCare Manitoba for undertaking all theanalyses for both Manitoba and British Columbia.viviiExecutive SummaryThis pilot study had two aims: to assess the feasibility of linking Citizenship and ImmigrationCanada’s (CIC) immigrant landing file to the provincial health records of Manitoba and BritishColumbia; and to provide a preliminary assessment of the medical screening process bydescribing the health status of recently arrived immigrants in Manitoba and British Columbia,and their medical services utilization.CIC’s landing file of immigrants whose stated province of destination was Manitoba or BritishColumbia and whose landing date was in 1995 or 1996 was linked by probabilistic record linkagetechniques to the respective provincial population registration and health databases.  The hospitaldischarges and physician claims were available in both provinces.  In addition, the communicablediseases database and the cancer registry were available in Manitoba.  Health status and the useof medical services were determined for three length of residence categories (from landing date):0-6 months, 7-12 months, and 0-12 months.  Other residents of Manitoba and British Columbiawere used as the comparison groups.  For these other residents, their service use and outcomes in1995 were examined.  Direct age-standardized rates were calculated using the 1996 Canadiancensus population as the standard population.Of those immigrants who were landed in 1995 or 1996 and whose stated intended destinationwas Manitoba, 84.5% were linked to the provincial population registration file and for thosedestined to British Columbia 81.1% were linked.  The percentage of records linked variedconsiderably by demographic and socio-economic characteristic.  For example, in Manitoba thepercentage linked varied from 62% for immigrants born in the Middle East, to 100% for thoseborn in Oceania; while in British Columbia it ranged from 55% for those born in North Africa, to89% for immigrants born in Southern Europe.  Differences of over 20% were also found forvarious visa categories.  Thus, large proportions of some groups are not going to their intendedprovince of residence.Compared to the general population in Manitoba or British Columbia, the physician visitationrates were approximately 40% lower among immigrants during their first year of residence inCanada.  For males, the hospitalization rates were approximately 60% lower, while for females itwas 50% lower in British Columbia, but only 25% lower in Manitoba.  However, for variousspecific conditions and procedures the immigrants had higher rates.  For physician visits but nothospitalizations, male immigrants had substantially higher utilization rates than the Manitobamales for Infectious and parasitic diseases.  For females, although the rates for Infectious andparasitic diseases were comparable to Manitoba women, the immigrant / Manitoba ratio was oneof the highest of all diagnostic groupings.  This was also reflected in Manitoba’s CommunicableDisease database, which showed immigrants had higher rates of tuberculosis, rubella, hepatitis B,and malaria.  The most consistent finding between the provinces was the high utilization ofmedical service by the immigrant women for pregnancy-related conditions.  The rates wereparticularly high in the second six months of residence.  Immigrants also tended to have highrates for eye surgery.  Although based on a small number of cases, linkage of the CIC landing fileto the Manitoba Cancer Registry suggests that, relative to the general Manitoba population, thenew immigrants have a high incidence of benign and in situ neoplasms.viiiThe utilization of medical services by immigrants varied substantially according to theirdemographic, socio-economic and existing medical conditions.  For example, in both Manitobaand British Columbia there were large variations in physician and hospital utilization accordingto region of birth, although the patterns were not similar between the two provinces.  Immigrantson a Refugee visa or a Family visa tended to utilize physicians and hospitals the most, whilethose on an Economic-Business visa tended to utilize them the least.  Immigrants whose medicalprofile assessment indicated that they had a medical condition or who had a medical condition oflanding imposed also tended to utilize physicians and hospitals to a greater degree than otherimmigrants.This pilot study has demonstrated the feasibility of linking CIC’s landing file to provincial healthdatabases.  These databases can be used to provide not only an assessment of CIC’s medicalscreening, but to provide information on the health status and medical service requirements ofimmigrants.  Such information could be of great value to provincial governments in developinghealth policy, programs and services for immigrants.11.  IntroductionThe Canadian government, much like the governments of most countries that receive largenumber of immigrants, requires that immigrants undergo medical screening. The purpose of thismedical examination is twofold. One reason is to ensure that the immigrants do not have someserious communicable disease that could put Canadians at risk. Secondly, medical screening isrequired to ensure that the immigrants do not have a serious illness or disease that would requireextensive medical treatment and result in a substantial financial burden to the Canadian taxpayer.Evaluation of the success of the screening procedure is difficult, as with minor exception there isno active follow-up of the immigrants after they arrive in Canada. Indirect follow-up of thehealth status of immigrants and their use of medical services is potentially possible through thevarious population-based administrative health databases that are maintained by provincialgovernments. The challenge here is to undertake probabilistic linkage to identify individualscommon to both the immigration and administrative health databases.The broad objectives of this pilot study are:· To assess the feasibility of linking Citizenship and Immigration Canada’s (CIC) immigrantlanding file to the administrative health records of Manitoba and British Columbia.· To provide a preliminary assessment of the medical screening process by describing thehealth status of recently arrived immigrants in Manitoba and British Columbia and theirmedical services utilization.2.  Methods2.1 Data sources2.1.1 Immigrant landing fileCIC forwarded files to British Columbia and to Manitoba containing the landing and medicalinformation for those immigrants who landed in Canada between 1994 and 1998 and whoindicated that they were destined to these provinces. The file included the immigrant’s name, andother unique identifiers, e.g. birth date, as these were required in order to link the landing file tothe provincial health databases. Socio-economic and demographic information on theseimmigrants were also included in the files and was used to stratify the analyses.Regarding the use of data in the study, two significant aspects should be noted. First, allimmigration applicants who complete their medical requirements in their country of origin sign aform stating that they give permission to the Federal Department to follow-up and inspect recordsof their previous and subsequent medical services. Second, researchers did not have access to anypersonally identifiable data.  In order to preserve individual privacy, the data managers assignedstudy identifiers to the data records, and only these identifiers were passed to the researchers foranalysis.22.1.2 ManitobaIn Manitoba the morbidity and medical service utilization information was derived from variousManitoba Health databases including the population registration, hospital discharge, physicianclaims, communicable diseases databases, and CancerCare Manitoba’s Cancer Registry.2.1.3 British ColumbiaMorbidity and medical service utilization data for immigrants in British Columbia were derivedfrom various provincial databases including the Linkage Coordinating file based on theRegistration and Premium Billing (R&PB) file, hospital discharges, and physician claims. Thesedata are available from the Centre for Health Services and Policy Research at University ofBritish Columbia; a formal protocol is in place to review data access requests and grant suchpermission by each of the data stewards at the British Columbia Ministry of Health.2.2 Record Linkage2.2.1 ManitobaThe CIC Landing file for immigrants whose intended destination was Manitoba was initiallylinked to Manitoba Health’s Population Registry using both deterministic and probabilisticrecord linkage techniques. The purpose of undertaking this linkage was to obtain the PersonalHealth Identification Number (PHIN) of the newly arrived immigrants. Once their PHIN hadbeen identified, it was possible to undertake a straight forward deterministic linkage to the otherManitoba Health databases as they all contain the PHIN.In order to expedite the linkage to the Manitoba Population Registry, the first linkage wasrestricted to those Manitobans who were registered as of January 1, 1995 or later. Then, for thoseindividuals who did not link, the linkage was attempted using all individuals in the PopulationRegistry who had registered after 1989. This was done in case there may have been an error inrecording the landing data in the landing file and because some immigrants had entered Canadaprior to obtaining permanent residency status and may have been eligible for provincial healthinsurance coverage. The variables used to undertake the record linkage were surname, givenname, date of birth and sex.Approval for the Manitoba portion of the study was provided by Manitoba Health’s Access andConfidentiality Committee and the University of Manitoba’s Committee on the Use of HumanSubjects in research.2.2.2 British ColumbiaRecords of persons indicating British Columbia as the province of destination in 1995 and 1996in the CIC Landing file were linked to the Centre for Health Services and Policy ResearchLinkage Coordinating file. This provided the identification of the Personal Health Number(PHN) which is used on all care transaction records in British Columbia. Since the LinkageCoordinating file is based on the periodically updated Registration and Premium Billing Files3(R&PB), we were able to link records for persons who, apparently, had obtained health insuranceprior to obtaining landed status, that is, before 1996 and 1995. The reasons for such occurrencesare the same as in Manitoba: data recording error or residency in the province prior to becominga landed immigrant.The variables used to undertake the record linkage were surname, given name(s), sex, and date ofbirth. Probabilistic record linkage techniques were used.The University of British Columbia’s Ethics Review Committee approved the study.2.3 Arrival, landing and coverage datesThere were several issues related to the arrival and landing dates that complicated the analyses.Since the intent of this pilot study is to assess the utility of CIC’s medical screening program, thelanding date was used as the basis for the analyses. For immigrants whose landing date was in1995 or 1996, health status and the use of medical services were determined for three length ofresidence categories (from their landing date): 0-6 months, 7-12 months, and 0-12 months.However, as indicated by the arrival date, it needs to be recognized that an appreciable number ofimmigrants had been in British Columbia or Manitoba prior to their actual landing date. InManitoba, for example, in the total file provided by CIC 1320 immigrants or 9.2% had an arrivaldate prior to the landing date. In the linked file (only 1995, 1996 landings) 1134 immigrants, or10.6%, had an arrival date prior to their landing date. The assumption was made that the landingdate reflects the date of arrival in British Columbia or Manitoba.In contrast, for those immigrants applying from outside Canada, and whose port of entry wasBritish Columbia or Manitoba, the landing date provides an accurate date of arrival in theseprovinces. However, some immigrants whose port of entry was other than British Columbia orManitoba may have delayed proceeding to these provinces and thus the landing date may notaccurately reflect the date they arrived in the province.The registration files maintained by Manitoba Health and the British Columbia Ministry ofHealth and Ministry Responsible for Seniors for the purposes of administering their healthinsurance programs contain information on the date that coverage was started and terminated.The coverage start date is meant to reflect the landing date and not the date that the immigrantfirst registered for medical coverage. Coverage may be terminated due to out-migration or death.Just as the arrival date is often prior to the landing date, it is also often prior to the coverage startdate. In the linked Manitoba file 2575 immigrants (23.5%) had a start of medical coverage dateprior to their landing date. For 1854 of these, their coverage start date was more than one yearbefore their landing date. In British Columbia 12,233  (15.6%) immigrants had a medicalcoverage start date before their landing date and for 6,845 (56.0%) of these the start date wasmore than a year prior to their landing date.42.4 Variable recodingFor analytical purposes several variables (visa category, country of birth, conditions of landingimposed, medical profile assessment, physician diagnoses, hospital diagnoses and procedures)were aggregated into groups. Ap endix I provides the components of each of the aggregatedgroups.2.5 AnalysesSince the population registries in Manitoba or British Columbia were not complete for the yearsafter 1996, the analyses were restricted to immigrants who landed in 1995 or 1996. Althoughsome immigrants were in Manitoba or British Columbia prior to their official landing date, onlythose services or health outcomes that occurred within the first year after the landing date, oruntil medical coverage was cancelled, were included in the analyses. In order to calculate rates,person-years were determined. Immigrants who were residents of Manitoba or British Columbiafor the entire year after landing contributed one person-year to the denominator, while person-years for those whose coverage was cancelled prior to one year of residence was calculated as:person-years = (cancellation date – landing date) / 365.25The person-years were then summed and formed the denominator for calculating the rates.Other residents of Manitoba and British Columbia were used as the comparison groups.Although we often refer to these comparison groups as non-immigrants, it should be noted that infact they include immigrants who had arrived in Manitoba or British Columbia prior to 1995.Ideally we would have compared the newly arrived immigrants on the CIC data file with twocomparison groups in each province: longer-term immigrants and native-born Canadians.Unfortunately, this was not possible as neither Manitoba nor British Columbia record country ofbirth in their administrative files. For these other residents, their service use and outcomes in1995 were examined. Only those persons resident in the two provinces for the entire year wereincluded in the analyses.Age-specific and overall crude rates for service utilization and health outcomes were calculatedfor the immigrants in the CIC file and the remainder of the population in each of the twoprovinces. For immigrants, age at immigration based on the landing date was used for theanalyses. For the remainder of the provincial residents, age as of January 1, 1995 was used.Individual years of age were aggregated into the following grouped age categories: 0-14, 15-24,25-34, 35-44, 45-54, 55-64, and 65+.Given that the age distribution of new immigrants was very different than the remainder of thepopulation in the destination province, it was necessary to calculate age-standardized rates so thatmeaningful comparisons could be made between the two groups. The direct method of age-standardization was used and the 1996 Canadian census population was used as the standardpopulation.53.  Results3.1 Record linkageFor the years 1995 and 1996 the landing file for Manitoba contained 7,532 records while that forBritish Columbia contained 96,600 records (Table 3.1). In Manitoba 84.5% were linked to thePopulation Registry and in British Columbia 81.1% of the records were linked to the LinkageCoordinating file.As described below, the proportion of missing links was not uniform across the variousimmigrant characteristics.3.1.1 Landing yearIn Manitoba, 75.2% of immigrant landing records for the years 1995-98 were linked to theManitoba Population Registry, however, this varied substantially by year (T ble 3.1). There wasa low percentage of links for the more recent years, particularly 1998 for which only 46.4% of therecords linked. In contrast, for 1995 and 1996 the overall linkage was 84.5%. This does not implythat the quality of the CIC information required to do the linkage was poorer in more recentyears, but rather, the incompleteness of the Manitoba Population Registry in the latter years.Copies of the Population Registry are provided to Manitoba Health’s Epidemiology Unit onlysemi-annually. Thus the version used in the present analysis did not have all recent registrations.Consequently, it was decided to limit the analyses to individuals who landed in 1995 or 1996. AsBritish Columbia was in a similar situation with the R&PB files, only records for 1995 and 1996were linked in that province as well. For those two years the linkage percentage was comparableto that in Manitoba (81.1%).Table 3.1 Percent of immigrants linked by landing year and intended province of residenceManitoba British ColumbiaLanding Year Number Percent Linked Number Percent Linked1995 3609 84.7 44581 82.41996 3923 84.4 52019 79.91997 3765 70.41998 2998 46.41995-96 7532 84.5 96600 81.11995-98            14295 75.23.1.2 SexThere was a slight difference in the percentage linked by sex, but the difference was notconsistent across the two provinces (Tabl  3.2).  In British Columbia 2.9% more males thanfemales were linked, while in Manitoba 2.3% more records were linked for females than formales.6Table 3.2 Percent of immigrants landed in 1995 and 1996 linked by sex and intended province ofresidenceManitoba British ColumbiaSex Number Percent Linked Number Percent LinkedMale 3702 83.4 45980 82.6Female 3830 85.6 50620 79.73.1.3 AgeThere were substantial differences in the percentage linked among the various age categories(Table 3.3). In Manitoba the 55-64 year old immigrants had the highest percentage of links(91.1%) and immigrants aged 35-44 had the lowest (81.4%). In British Columbia thoseimmigrants aged 55-64 also had the highest percentage of links (85.9%), while those aged 25-34had the lowest percentage linked (77.8%).Table 3.3 Percent of immigrants landed in 1995 and 1996 linked by age and intended province ofresidenceManitoba British ColumbiaAge Number Percent Linked Number Percent Linked  0-14 1653 81.7 20840 81.215-24 1236 90.2 14739 83.925-34 2275 83.7 22718 77.835-44 1335 81.4 20582 79.445-54  484 85.7   8972 84.655-64  326 91.1   5115 85.9    65+  223 88.3   3632 83.73.1.4 Marital statusIn Manitoba Separated immigrants had the highest percentages of links (92.9%), although thiswas based on a small number of immigrants, while Single (84.4%) and Married (84.3%)immigrants had the lowest (Table 3.4). In British Columbia the widowed had the highestpercentage of linked records (86.5%). The percentages for the other marital statuses were fairlycomparable.Table 3.4 Percent of immigrants landed in 1995 and 1996 linked by marital status and intendedprovince of residenceManitoba British ColumbiaMarital status Number Percent Linked Number Percent LinkedSingle 3207 84.4 39975 81.1Married 4027 84.3 52713 80.9Widowed   178 89.9   2363 86.5Divorced     92 88.0   1184 79.1Separated     28 92.9     364 82.473.1.5 Region of birthThere was marked variation in linkage according to region of birth (Table 3.5). Only 54.7% ofimmigrants destined for British Columbia and born in North Africa linked. Although thepercentage for North Africans was higher in Manitoba (71.0%), they still ranked among thegroups with the lowest percentage of links. In Manitoba, immigrants born in the Middle East hadthe lowest linkage percentage (61.8%). All immigrants born in Oceania who were destined forManitoba linked, although only 82.2% linked in British Columbia. The Southern Europeans inboth Manitoba (95.1%) and British Columbia (88.8%) had the highest percentage of links.Table 3.5 Percent of immigrants landed in 1995 an 1996 linked by region of birth and intendedprovince of residenceManitoba British ColumbiaRegion of birth Number Percent Linked Number Percent LinkedUK & Ireland   364 91.5   2532 81.5NW Europe   216 90.7   2273 81.2Southern Europe   944 95.1   2516 88.8Eastern Europe   245 67.8   1741 81.0Former USSR   277 81.2   1890 76.1Middle East   343 61.8   3656 77.7North Africa     69 71.0     505 54.7Central & West Africa   115 85.2     310 77.1South & East Africa   309 91.9   1982 79.0South Asia   891 79.3 13437 85.9Northeast Asia 1239 70.9 50733 79.2Southeast Asia 1743 93.3   9282 86.5North America   243 88.5   2302 81.0Caribbean   120 89.2     387 77.0Central America   221 90.0    964 84.9South America   147 86.4    629 76.0Oceania     46           100.0  1461 82.23.1.6 Visa categoryIn both Manitoba and British Columbia immigrants on an Economic-Skilled-Family visa had asubstantially lower percentage of links than did immigrants on other types of visas (66.6% and71.8% respectively – Table 3.6).  In Manitoba more than 90% of records for those on a Family,Refugee, or Other visa were linked, while in British Columbia only the Refugees surpassed a90% linkage.8Table 3.6 Percent of immigrants landed in 1995 an 1996 linked by visa category and intendedprovince of residence                 Manitoba           British ColumbiaVisa category Number Percent Linked Number Percent LinkedFamily 2536 92.9 29598 85.3Economic-Skilled-Family 1869 66.6 26270 71.8Economic-Skilled-Independent   998 81.9 16356 79.5Economic-Business  434 81.3 16740 85.0Refugee 1349 93.2   4143 93.4Other   346 98.3   3493 89.43.1.7 Medical profile assessmentImmigrant’s may have two medical profile assessments. If the immigrant’s assessment categorywas 2-7 on either of the two assessments they were classed as having a ‘medical condition’. Forthe purposes of this report the results from the two assessments were combined. If theirassessment category was 0, 1 or missing on both assessments they were classified as having nomedical condition.Slightly more immigrants who were assessed as having a medical condition linked in bothManitoba and British Columbia than did those who did not have a condition (Table 3.7).Table 3.7 Percent of immigrants landed in 1995 and 1996 linked by medical profile assessmentand intended province of residenceManitoba British ColumbiaMedical assessment Number Percent Linked Number Percent LinkedNo conditions 7218 84.4 92704 81.0Conditions   314 85.7   3896 82.93.1.8 Conditions of landingIn both Manitoba and British Columbia more immigrants who had a medical condition of landinglinked than did those who had an Other condition (e.g must marry within 90 days of landing) orNo condition (Table 3.8). In Manitoba, immigrants who had Other conditions of landing hadsubstantially lower links the other two categories.Table 3.8 Percent of immigrants landed in 1995 and 1996 linked by conditions of landing andintended province of residenceManitoba British ColumbiaConditions of landing Number Percent Linked Number Percent LinkedNone    6827 84.7 81841 80.5Medical 394 90.1   5629 83.9Other 311 73.0   9130 82.193.2 Physician claimsThe physician claims rate of the newly arrived immigrants was approximately 40 percent lowerthan that of other residents of Manitoba (Table 3.9) and British Columbia (T ble 3.10). InManitoba, during the first year male immigrants had on average 5.3 (age-standardized) visits perperson while females averaged 7.6 visits. This compared to 9.1 and 12.9 visits per person forother Manitoba men and women. All residents of British Columbia had, on average, morephysician visits than did those of Manitoba, although the immigrant / non-i migrant ratios werecomparable to those in Manitoba. During the first year the age-standardized visitation rate forimmigrants in British Columbia was 8.6 per person for males and 13.0 for females, while fornon-immigrants they were 14.8 and 21.2 respectively.Manitoba immigrants visited physicians somewhat more during their first six months ofresidence than in the subsequent six month period. In contrast, in British Columbia the utilizationof physicians went up with increasing length of residence. These provincial patterns were fairlypervasive across all the characteristics examined below.3.2.1 AgeWith the exception of female immigrants aged 15-24 years resident in British Columbia for 7-12months, immigrants of all ages in both Manitoba and British Columbia had a lower number ofphysician claims per person than other residents of these provinces (Tables 3.9, 3.10). InManitoba the general decrease in physician utilization with increased length of residence wasobserved for males of all ages except those aged 35-44 years. For females, although overall thoseresident in Manitoba for the shorter time period had more physician claims than longer termresidents, this was not true for women aged 15-54. In British Columbia the number of physicianvisits increased with increasing length of residence for male and female immigrants of all ages.10Table 3.9 Physician claim number and average claims per person by age, sex and length ofresidence, ManitobaImmigrants Non-         0-6 Months  7-12 Months   0-12 Months Immig Relative rates1Age No.   Av/per No. Av/per No. Av/per  Av/per  0-6 M 7-12 M 0-12 MMales  0-14 1665 4.7 1388 4.1 3053 4.4 6.2 0.76 0.65 0.7115-24 997 4.2 725 3.1 1722 3.7 5.0 0.83 0.62 0.7225-34 1915 4.3 1618 3.8 3533 4.0 6.2 0.68 0.60 0.6435-44 1012 3.9 1030 4.1 2042 4.0 7.6 0.51 0.54 0.5245-54 699 7.1 515 5.5 1214 6.3 10.0 0.72 0.55 0.6455-64 539 8.2 358 5.7 897 6.9 13.7 0.60 0.41 0.51     65+ 494 12.0 310 7.7 804 9.9 20.2 0.59 0.38 0.49Total 7321 4.9 5944 4.1 13265 4.5 8.9 0.55 0.46 0.51Total-stand rate 5.9 4.7 5.3 9.1 0.65 0.51 0.58Females  0-14 1589 5.1 1152 3.8 2741 4.4 6.3 0.81 0.60 0.7115-24 2566 8.2 2508 8.3 5074 8.3 11.2 0.74 0.74 0.7425-34 3993 8.4 4146 9.0 8139 8.7 13.4 0.63 0.67 0.6535-44 1452 5.5 1617 6.2 3069 5.8 12.5 0.44 0.50 0.4745-54 805 7.7 807 8.0 1612 7.9 14.9 0.52 0.54 0.5355-64 776 9.6 541 6.9 1317 8.3 17.0 0.56 0.41 0.49     65+ 775 13.8 578 10.5 1353 12.2 20.8 0.67 0.51 0.59Total 11956 7.5 11349 7.3 23305 7.4 13.1 0.57 0.56 0.56Total-stand rate 7.9 7.3 7.6 12.9 0.61 0.56 0.591 Relative to age-specific and total rates for other residents of Manitoba11Table 3.10 Physician claim number and average claims per person by age, sex and length ofresidence, British ColumbiaImmigrants Non-         0-6 Months  7-12 Months   0-12 Months Immig Relative rates1Age No.   Av/per No. Av/per No. Av/per  Av/per  0-6 M 7-12 M 0-12 MMales  0-14 16062 3.7 23386 5.6 39448 4.7 8.3 0.45 0.68 0.5615-24 12987 4.9 19089 7.6 32076 6.2 8.9 0.55 0.85 0.7025-34 23932 6.2 31259 8.6 55191 7.4 12.8 0.49 0.67 0.5835-44 17871 4.6 29914 7.9 47785 6.2 14.1 0.32 0.56 0.4445-54 12176 6.3 20783 11.0 32959 8.6 16.0 0.39 0.69 0.5455-64 11424 11.5 16231 17.1 27655 14.2 21.5 0.54 0.79 0.66     65+ 10910 17.0 12586 20.7 23496 18.8 29.8 0.57 0.69 0.63Total 105362 5.8 153248 8.7 258610 7.2 15.2 0.38 0.57 0.47Total-stand rate 7.0 10.3 8.6 14.8 0.47 0.69 0.58Females  0-14 12956 3.3 19600 5.1 32556 4.2 8.1 0.41 0.64 0.5215-24 36863 11.4 54747 17.9 91610 14.6 17.1 0.67 1.05 0.8525-34 64164 14.3 81231 19.2 145395 16.6 25.3 0.56 0.76 0.6635-44 33786 8.5 49742 13.0 83528 10.7 22.6 0.38 0.58 0.4745-54 19959 11.5 28882 17.2 48841 14.3 24.3 0.47 0.71 0.5955-64 20152 17.5 22589 20.5 42741 19.0 27.1 0.65 0.76 0.70     65+ 14519 17.4 16374 20.4 30893 18.9 32.9 0.53 0.62 0.57Total 202399 10.5 273165 14.8 475564 12.6 22.2 0.47 0.67 0.57Total-stand rate 11.0 15.1 13.0 21.2 0.52 0.71 0.611 Relative to age-specific and total rates for other residents of British Columbia3.2.2 DiagnosisFor both the immigrants and the remainder of the Manitoba population Respiratory diagnoseswere the most common among males and V code diagnoses the most common among females(Table 3.11). With the exception of Infectious diseases and Pregnancy, the physician claims ratesin the first year of residence in Manitoba were lower for the recent immigrants than otherManitobans across all the various diagnostic code groupings. The ratios for Chiropractic visits(males 0.16, females 0.17) and Neoplasms (males 0.19, females 0.33) were particularly low.For both males and females the overall physician claims rate was slightly higher in the first sixmonths than in the subsequent six months. For males, the Chiropractic rate was lower in the firstsix months, while rates for Perinatal conditions and Injuries and poisonings were comparable inthe first and second six month periods. Females had several diagnosis categories for which therates were lower in the first six months than in the second six months, but the largest differencesoccurred for Pregnancy-related claims.In British Columbia, since the physician claims records have only recently incorporateddiagnostic information, these data were not available for the years under study.12Table 3.11 Physician claim number and age-standardized rate (per 1,000) by diagnosis, sex andlength of residence, ManitobaImmigrants Non-         0-6 Months  7-12 Months   0-12 Months Immig Relative rates1Diagnosis No.     Rate No. Rate No.  Rate   Rate  0-6 M 7-12 M 0-12 MMalesInfectious 444 307.1 380 275.8 824 291.7 182.6 1.68 1.51 1.60Neoplasms 60 53.1 72 50.6 132 51.8 266.2 0.20 0.19 0.19Endocrine 149 207.5 124 158.6 273 183.4 337.4 0.62 0.47 0.54Blood 80 72.3 27 24.8 107 48.8 81.4 0.89 0.30 0.60Mental 243 189.5 216 150.8 459 170.4 383.9 0.49 0.39 0.44Nervous, sens 691 558.1 537 452.7 1228 506.4 852.1 0.65 0.53 0.59Circulatory 354 536.4 284 420.0 638 479.0 774.9 0.69 0.54 0.62Respiratory 1266 900.3 1065 731.0 2331 816.7 1008.5 0.89 0.72 0.81Digestive 370 284.8 354 259.3 724 272.2 381.4 0.75 0.68 0.71Genitourinary 167 148.8 144 141.5 311 145.3 308.6 0.48 0.46 0.47Skin 461 318.0 403 266.1 864 292.4 392.6 0.81 0.68 0.74Musculoskeletal 320 259.3 334 239.1 654 249.3 585.4 0.44 0.41 0.43Congenital 33 20.4 22 12.8 55 16.7 20.1 1.02 0.64 0.83Perinatal 1 0.6 1 0.6 2 0.6 1.1 0.51 0.52 0.52Ill-defined 750 598.9 574 456.1 1324 528.8 592.7 1.01 0.77 0.89Injuries, poison 446 301.7 474 301.6 920 301.6 664.3 0.45 0.45 0.45V codes 793 644.9 358 299.5 1151 474.6 950.1 0.68 0.32 0.50Chiropractic 183 92.6 252 150.2 435 120.8 751.1 0.12 0.20 0.16Unknown 510 440.8 323 261.3 833 352.4 600.1 0.73 0.44 0.59FemalesInfectious 409 276.9 362 215.6 771 246.5 239.8 1.15 0.90 1.03Neoplasms 102 90.3 144 108.6 246 99.3 299.2 0.30 0.36 0.33Endocrine 278 313.1 247 248.7 525 281.2 395.9 0.79 0.63 0.71Blood 122 65.1 133 77.7 255 71.3 135.7 0.48 0.57 0.53Mental 283 192.1 384 224.8 667 208.2 614.4 0.31 0.37 0.34Nervous, sens 790 618.6 655 516.6 1445 568.2 1112.7 0.56 0.46 0.51Circulatory 474 581.9 378 458.1 852 520.9 730.0 0.80 0.63 0.71Respiratory 1320 863.6 1234 815.3 2554 839.8 1291.9 0.67 0.63 0.65Digestive 410 274.7 366 275.6 776 275.2 438.0 0.63 0.63 0.63Genitourinary 1384 668.6 1321 677.8 2705 673.0 1139.6 0.59 0.59 0.59Pregnancy 415 164.0 739 301.4 1154 231.7 203.6 0.81 1.48 1.14Skin 599 321.8 622 354.2 1221 337.6 484.4 0.66 0.73 0.70Musculoskeletal 471 434.2 495 436.7 966 435.4 819.2 0.53 0.53 0.53Congenital 20 14.6 8 4.0 28 9.4 19.1 0.76 0.21 0.49Perinatal 4 2.3 2 0.9 6 1.6 1.8 1.26 0.48 0.88Ill-defined 1012 688.4 905 625.9 1917 657.6 855.4 0.80 0.73 0.77Injuries, poison 420 294.1 417 287.4 837 290.7 576.8 0.51 0.50 0.50V codes 2161 1241.6 1969 1002.5 4130 1123.5 1870.1 0.66 0.54 0.60Chiropractic 228 124.8 273 176.1 501 149.9 889.0 0.14 0.20 0.17Unknown 1054 660.9 695 448.6 1749 556.4 805.3 0.82 0.56 0.691 Relative to diagnosis-specific age-standardized rates for other residents of Manitoba133.2.3 Visa categoryWith the exception of females in Manitoba, immigrants in both provinces on a Refugee visa hadthe highest number of physician visits per person followed by immigrants on a Family visa(Table 3.12, 3.13). Among Manitoba female immigrants, those on a Family visa had the highestaverage number of visits followed by Refugees. In both provinces men and women immigrantson an Economic-Business visa utilized physicians the least. These patterns existed both at 0-6and 7-12 months residence. Only male Refugees in British Columbia utilized physicians morethan the other British Columbia residents. In Manitoba, immigrants, regardless of visa type, hadlower physician utilization rates than other Manitobans.Table 3.12 Physician claim number and age-standardized claims per person by visa category, sexand length of residence, ManitobaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Visa category  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesFamily 3176 7.0 2242 5.0 5418 6.0 0.77 0.55 0.66Econ-Skill-Fam 1053 3.7 1066 4.1 2119 3.9 0.40 0.44 0.42Econ-Skill-Ind 819 3.6 731 3.2 1550 3.4 0.39 0.35 0.37Econ-Business 174 1.7 203 1.9 377 1.8 0.18 0.20 0.19Refugee 1886 7.3 1478 6.1 3364 6.7 0.80 0.67 0.73Other 213 3.4 224 3.1 437 3.3 0.37 0.34 0.36FemalesFamily 6614 9.6 6318 8.9 12932 9.2 0.74 0.69 0.71Econ-Skill-Fam 1273 4.7 1560 5.9 2833 5.3 0.37 0.46 0.41Econ-Skill-Ind 1029 7.0 895 4.3 1924 5.7 0.54 0.33 0.44Econ-Business 208 4.1 251 4.0 459 4.0 0.31 0.31 0.31Refugee 2202 9.1 1873 6.8 4075 8.0 0.70 0.53 0.62Other 630 5.4 452 2.9 1082 4.1 0.42 0.22 0.321 Relative to total age-standardized rate for other residents of Manitoba (males 9.1, females 12.9)14Table 3.13 Physician claim number and age-standardized claims per person by visa category, sexand length of residence, British ColumbiaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Visa category  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesFamily 52840 10.0 68486 13.0 121326 11.5 0.68 0.88 0.77Econ-Skill-Fam 17513 7.1 27621 8.6 45134 7.8 0.48 0.58 0.53Econ-Skill-Ind 9735 3.9 19691 9.7 29426 6.8 0.27 0.65 0.46Econ-Business 10030 3.7 21344 7.5 31374 5.6 0.25 0.51 0.38Refugee 11196 16.3 11721 14.3 22917 15.4 1.10 0.97 1.04Other 4048 8.2 4385 10.3 8433 9.3 0.55 0.70 0.62FemalesFamily 114432 15.7 146929 20.3 261361 17.9 0.74 0.96 0.85Econ-Skill-Fam 29238 9.0 42867 12.3 72105 10.6 0.42 0.58 0.50Econ-Skill-Ind 15646 5.8 28547 12.6 44193 9.1 0.27 0.60 0.43Econ-Business 14132 5.3 26529 9.0 40661 7.1 0.25 0.42 0.34Refugee 13154 19.4 14906 20.7 28060 20.0 0.91 0.98 0.95Other 15797 18.1 13387 16.0 29184 17.1 0.85 0.76 0.811 Relative to total age-standardized rate for other residents of British Columbia (males 14.8, females 21.2)3.2.4 BirthplaceFor their first year in Manitoba, only male immigrants born in the Middle East had higherphysician utilization than other Manitobans, although some groups did have higher averagenumber of visits within specific length of residence categories (Table 3.14). Relative to otherimmigrant groups, males and females from South Asia, males from the Middle East and femalesfrom Central and West Africa utilized physicians frequently. Those groups with the lowestaverage number of visits per person included immigrants born Oceania, males born in North andWest Europe and females born in Northeast Asia and the United Kingdom and Ireland. In BritishColumbia only immigrants from Central and West Africa and females from North Africa andNorth America had higher rates in their first year of residence than other British Columbians(Table 3.15). Immigrants born in North and West Europe and in Northeast Asia had the lowestnumber of physician contacts per person.The immigrant groups that were the lowest users of physicians over the first year, tended to bethe lowest users in both periods of residence. However, among the high users there were somechanges by length of residence.  For example, in British Columbia, males born in the Caribbeanhad the highest rate of all groups during the first six months of residence but they were amongthe lowest during the 7-12 month period.While overall the average number of physician visits declined with increasing length of residencein Manitoba, this was not the case for all immigrant groups. The largest increases occurredamong females born in Central and West Africa. In contrast to Manitoba, in British Columbia therates increased with length of residence except for a few immigrant groups (Former USSR, malesfrom Central and West Africa, Caribbean, and Central America).15Table 3.14 Physician claim number and age-standardized claims per person by birthplace, sexand length of residence, ManitobaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Birthplace  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesUK & Ireland 229 3.3 302 4.3 531 3.8 0.36 0.47 0.42N & W Europe 92 1.1 125 2.4 217 1.8 0.12 0.27 0.19South Europe 725 4.4 718 4.5 1443 4.4 0.48 0.49 0.49Eastern Europe 139 3.5 119 2.7 258 3.1 0.39 0.30 0.34Former USSR 148 2.6 219 3.5 367 3.0 0.28 0.39 0.33Middle East 720 11.3 407 8.1 1127 9.7 1.24 0.88 1.07North Africa 74 8.8 49 4.5 123 6.7 0.97 0.50 0.73C & W Africa 150 3.6 101 3.3 251 3.4 0.39 0.36 0.38S  & E Africa 445 9.3 262 4.5 707 7.1 1.01 0.49 0.78South Asia 1349 9.1 1061 7.3 2410 8.2 1.00 0.80 0.90Northeast Asia 619 4.0 464 2.9 1083 3.5 0.44 0.32 0.38Southeast Asia 1906 6.8 1463 5.1 3369 6.0 0.75 0.56 0.65North America 177 5.5 203 6.5 380 6.0 0.60 0.71 0.65Caribbean 160 6.8 104 4.1 264 5.4 0.74 0.45 0.60Central America 234 5.3 231 5.5 465 5.4 0.58 0.60 0.59South America 109 4.8 88 3.4 197 4.2 0.52 0.37 0.45Oceania 45 2.4 28 2.1 73 2.3 0.27 0.23 0.25FemalesUK & Ireland 282 3.8 320 4.9 602 4.4 0.30 0.38 0.34N & W Europe 236 4.6 217 5.2 453 4.9 0.35 0.40 0.38South Europe 1294 6.7 1235 6.1 2529 6.4 0.51 0.47 0.50Eastern Europe 400 6.9 376 7.2 776 7.1 0.53 0.56 0.55Former USSR 409 6.3 437 6.5 846 6.4 0.49 0.50 0.49Middle East 324 10.3 289 7.3 613 8.8 0.80 0.57 0.68North Africa 89 8.4 71 7.1 160 7.7 0.65 0.55 0.60C & W Africa 172 9.6 177 13.4 349 11.5 0.74 1.04 0.89S  & E Africa 745 9.4 613 8.4 1358 8.9 0.73 0.65 0.69South Asia 2068 12.1 1854 9.7 3922 10.9 0.94 0.75 0.85Northeast Asia 899 4.2 966 4.5 1865 4.3 0.32 0.35 0.34Southeast Asia 3546 8.4 3272 7.2 6818 7.8 0.65 0.56 0.61North America 450 9.1 428 8.3 878 8.7 0.70 0.64 0.67Caribbean 263 11.3 215 8.8 478 10.1 0.88 0.68 0.78Central America 386 7.4 448 7.9 834 7.7 0.57 0.61 0.59South America 332 8.9 367 11.1 699 10.0 0.69 0.86 0.77Oceania 61 4.2 64 4.5 125 4.4 0.33 0.35 0.341 Relative to total age-standardized rate for other residents of Manitoba (males 9.1, females 12.9)16Table 3.15 Physician claim number and age-standardized claims per person by birthplace, sexand length of residence, British ColumbiaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Birthplace  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesUK & Ireland 3383 7.9 4736 12.3 8119 10.0 0.53 0.83 0.67N & W Europe 1347 3.7 2016 5.9 3363 4.8 0.25 0.40 0.32South Europe 3636 7.3 4779 9.5 8415 8.4 0.49 0.64 0.56Eastern Europe 1978 9.0 2471 12.7 4449 10.8 0.60 0.86 0.73Former USSR 2519 15.2 2446 14.4 4965 14.8 1.03 0.97 1.00Middle East 6437 12.0 7994 13.8 14431 12.9 0.81 0.93 0.87North Africa 477 8.4 638 8.7 1115 8.8 0.57 0.58 0.59C & W Africa 1010 16.9 631 14.3 1641 15.6 1.14 0.96 1.05S  & E Africa 2979 9.1 3790 12.6 6769 10.8 0.61 0.85 0.73South Asia 27084 10.7 40380 15.9 67464 13.2 0.72 1.07 0.89Northeast Asia 33843 4.7 58321 7.4 92164 6.0 0.32 0.50 0.41Southeast Asia 10962 8.7 13734 11.5 24696 10.1 0.59 0.78 0.68North America 3952 10.4 4824 17.4 8776 13.8 0.70 1.17 0.93Caribbean 1185 17.1 518 8.6 1703 12.9 1.15 0.58 0.87Central America 1509 11.3 1589 10.5 3098 10.9 0.76 0.71 0.73South America 797 10.7 893 11.7 1690 11.1 0.72 0.79 0.75Oceania 2264 9.0 3488 16.0 5752 12.4 0.61 1.08 0.84FemalesUK & Ireland 5577 13.2 6712 16.1 12289 14.6 0.62 0.76 0.69N & W Europe 4236 10.9 5356 13.5 9592 12.2 0.51 0.64 0.58South Europe 6042 11.2 7604 16.3 13646 13.6 0.53 0.77 0.64Eastern Europe 4689 14.0 6024 19.3 10713 16.6 0.66 0.91 0.78Former USSR 4800 16.7 4727 16.3 9527 16.5 0.79 0.77 0.78Middle East 9177 17.0 11513 20.7 20690 18.8 0.80 0.98 0.89North Africa 891 21.5 1098 26.7 1989 23.7 1.01 1.26 1.12C & W Africa 1080 22.0 1115 23.0 2195 22.5 1.04 1.09 1.06S  & E Africa 4946 13.0 5499 16.3 10445 14.6 0.62 0.77 0.69South Asia 43591 14.5 69249 22.9 112840 18.6 0.68 1.08 0.88Northeast Asia 68219 7.5 103229 11.1 171448 9.3 0.35 0.53 0.44Southeast Asia 29959 14.6 31289 15.4 61248 15.0 0.69 0.73 0.71North America 9066 23.2 8231 23.6 17297 23.4 1.09 1.11 1.10Caribbean 1311 20.2 1052 20.8 2363 20.5 0.95 0.98 0.97Central America 2964 17.1 3208 23.5 6172 20.1 0.81 1.11 0.95South America 1666 14.5 2046 20.1 3712 17.2 0.68 0.95 0.81Oceania 4185 16.2 5213 17.9 9398 17.1 0.76 0.85 0.811 Relative to total age-standardized rate for other residents of British Columbia (males 14.8, females 21.2)173.2.5 LanguageIn Manitoba, during the first six months of residency immigrants who could not speak at leastone of the two official languages utilized physician more than immigrants who could(Table 3.16). This was also evident for females during the 7-12 month residency period. Maleimmigrants who spoke both languages had a higher average number of physician visits.Francophone males, and Francophone females resident in Canada for 0-6 months, utilizedphysicians the least. In British Columbia there was no pattern across the two length of residenceperiods and, over the entire year, there were little differences between the language groups(Table 3.17).Table 3.16 Physician claim number and age-standardized claims per person by Canadianlanguage spoken, sex and length of residence, ManitobaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Language  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesEnglish 3249 5.3 2887 4.4 6136 4.8 0.58 0.48 0.53French 50 1.9 46 2.9 96 2.4 0.21 0.31 0.26English, French 98 5.5 113 6.2 211 5.9 0.60 0.68 0.64Neither 3924 6.7 2898 4.9 6822 5.8 0.73 0.54 0.64FemalesEnglish 5526 7.3 5605 7.1 11131 7.2 0.57 0.55 0.56French 110 8.1 64 4.6 174 6.4 0.63 0.36 0.49English, French 79 3.4 93 5.0 172 4.2 0.26 0.39 0.32Neither 6241 8.6 5587 7.8 11828 8.2 0.66 0.60 0.631 Relative to total age-standardized rate for other residents of Manitoba (males 9.1, females 12.9)Table 3.17 Physician claim number and age-standardized claims per person by Canadianlanguage spoken, sex and length of residence, British ColumbiaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Language  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesEnglish 52287 7.7 72726 10.9 125013 9.2 0.52 0.73 0.62French 329 6.1 454 9.9 783 8.0 0.41 0.67 0.54English, French 999 5.8 1736 12.0 2735 8.8 0.39 0.81 0.59Neither 51747 6.9 78332 10.5 130079 8.6 0.46 0.71 0.58FemalesEnglish 100726 12.9 118581 14.7 219307 13.8 0.61 0.69 0.65French 877 12.4 1056 15.7 1933 14.0 0.58 0.74 0.66English, French 2281 11.3 2656 16.3 4937 13.8 0.54 0.77 0.65Neither 98515 10.3 150872 16.0 249387 13.1 0.49 0.75 0.621 Relative to total age-standardized rate for other residents of British Columbia (males 14.8, females 21.2)183.2.6 Medical profile assessmentImmigrants in both Manitoba and British Columbia who were classed as having a medicalcondition on either of two possible medical profile assessments had more physician visits thandid immigrants with no conditions (Tables 3.18, 3.19). The differences were particularly evidentin British Columbia. Despite their higher physician utilization, immigrants with conditions inboth Manitoba and British Columbia still had substantially lower number of visits per personthan other Manitobans or British Columbians.In Manitoba the average number of physician visits declined over time for both assessmentgroups. In British Columbia, however, they increased for both groups with the exception offemales with a condition.Table 3.18 Physician claim number and age-standardized claims per person by medical profileassessment, sex and length of residence, ManitobaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Assessment  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesNo condition 6978 5.9 5660 4.6 12638 5.2 0.64 0.50 0.57Condition 343 6.0 284 5.2 627 5.6 0.66 0.56 0.61FemalesNo condition 11388 7.8 10756 7.2 22144 7.5 0.61 0.56 0.58Condition 568 8.2 593 8.0 1161 8.1 0.64 0.62 0.631 Relative to total age-standardized rate for other residents of Manitoba (males 9.1, females 12.9)Table 3.19 Physician claim number and age-standardized claims per person by medical profileassessment, sex and length of residence, British ColumbiaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Assessment  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesNo condition 97379 6.8 144460 10.1 241839 8.4 0.46 0.68 0.57Condition 7983 12.2 8788 14.2 16771 13.2 0.82 0.96 0.89FemalesNo condition 184566 10.5 257248 14.9 441814 12.7 0.50 0.70 0.60Condition 17833 19.3 15917 18.7 33750 19.0 0.91 0.88 0.901 Relative to total age-standardized rate for other residents of British Columbia (males 14.8, females 21.2)193.2.7 Conditions of landingIn Manitoba, immigrants with medical conditions of landing visited physicians more than otherimmigrants, although only for males who had resided in Manitoba for 0-6 m nths was the ratehigher than for non-immigrants. Immigrants with ‘Other conditions’ visited physicians less thanthose immigrants with no conditions (Table 3.20). With the exception of females with ‘Otherconditions’ the average number of visits declined with increased length of residence in Manitoba.Table 3.20 Physician claim number and age-standardized claims per person by conditions oflanding imposed, sex and length of residence, ManitobaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Conditions  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesNone 6276 5.6 5254 4.6 11530 5.1 0.61 0.50 0.56Medical 892 9.4 565 5.9 1457 7.7 1.03 0.65 0.84Other 153 2.9 125 2.7 278 2.8 0.32 0.30 0.31FemalesNone 10692 7.9 10209 7.3 20901 7.6 0.61 0.56 0.59Medical 885 11.0 751 8.1 1636 9.6 0.85 0.63 0.74Other 379 5.1 389 5.3 768 5.2 0.40 0.41 0.401 Relative to total age-standardized rate for other residents of Manitoba (males 9.1, females 12.9)Table 3.21 Physician claim number and age-standardized claims per person by conditions oflanding imposed, sex and length of residence, British ColumbiaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Conditions  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesNone 87846 7.2 128180 10.7 216026 8.9 0.49 0.72 0.60Medical 11541 8.4 13450 10.8 24991 9.5 0.56 0.73 0.64Other 5975 4.4 11618 7.6 17593 6.0 0.30 0.51 0.40FemalesNone 174493 11.2 235502 15.6 409995 13.3 0.53 0.74 0.63Medical 17134 11.7 18312 14.4 35446 13.0 0.55 0.68 0.61Other 10772 6.9 19351 11.5 30123 9.1 0.33 0.54 0.431 Relative to total age-standardized rate for other residents of British Columbia (males 14.8, females 21.2)20Male immigrants in British Columbia with a medical condition of landing had slightly morevisits per person than immigrants with no conditions, but this was primarily due to their higherutilization in the first six month period (Table 3.21). For females, these two groups had acomparable number of visits per person. As was the case in Manitoba, those immigrants with‘Other conditions’ had the lowest average number of visits. Unlike Manitoba, physicianutilization rose for all three groups with increased length of residence in British Columbia.3.2.8 Marital statusIn both provinces immigrants of all marital statuses had lower physician utilization than the otherresidents  (Tables 3.22, 3.23). In Manitoba, Separated immigrants visited physicians the least,while Single males and Widowed females had the most visits per person. In British Columbia,Separated males also had the lowest overall first year rates, although during the 0-6 month periodMarried males saw physicians the least. Widowed males had the highest average number ofvisits. Married women in British Columbia made slightly more visits per person than Widowedwomen, although in the 0-6 month period Separated women had the highest number of visits.Single women utilized physicians the least.Table 3.22 Physician claim number and age-standardized claims per person by marital status, sexand length of residence, ManitobaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Marital status  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesSingle 3160 7.6 2499 6.2 5659 6.9 0.83 0.68 0.75Married 3931 4.9 3312 3.9 7243 4.4 0.54 0.42 0.48Widowed 170 4.6 80 1.6 250 3.2 0.50 0.17 0.35Divorced 60 3.4 48 2.3 108 2.8 0.37 0.25 0.31Separated 0 0.0 5 0.8 5 0.4 0.00 0.09 0.05FemalesSingle 3457 6.0 2996 4.7 6453 5.3 0.46 0.36 0.41Married 7382 7.3 7430 7.1 14812 7.2 0.57 0.55 0.56Widowed 811 10.9 614 8.4 1425 9.6 0.84 0.65 0.74Divorced 240 7.5 236 7.4 476 7.4 0.58 0.57 0.58Separated 66 4.9 73 4.1 139 4.5 0.38 0.32 0.351 Relative to total age-standardized rate for other residents of Manitoba (males 9.1, females 12.9)21Table 3.23 Physician claim number and age-standardized claims per person by marital status, sexand length of residence, British ColumbiaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Marital status  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesSingle 33454 10.0 47772 10.5 81226 10.3 0.68 0.71 0.69Married 68220 6.7 100623 9.7 168843 8.2 0.45 0.66 0.55Widowed 2247 10.3 2680 14.6 4927 12.4 0.70 0.98 0.83Divorced 1102 8.6 1852 12.4 2954 10.5 0.58 0.83 0.71Separated 339 7.7 321 6.3 660 7.2 0.52 0.42 0.48FemalesSingle 43329 10.7 56999 12.7 100328 11.7 0.50 0.60 0.55Married 138984 12.5 191561 17.0 330545 14.7 0.59 0.80 0.69Widowed 13914 12.2 17338 15.9 31252 14.0 0.58 0.75 0.66Divorced 4069 10.9 5452 14.6 9521 12.8 0.52 0.69 0.60Separated 2103 13.8 1815 13.9 3918 13.9 0.65 0.66 0.661 Relative to total age-standardized rate for other residents of British Columbia (males 14.8, females 21.2)3.2.9 EducationImmigrants in both provinces, regardless of their education qualifications, utilized physicians lessthan other residents (Tables 3.24, 3.25). Within Manitoba there was a fairly clear gradient of use,with those immigrants having no qualifications or less than Secondary qualifications having thehighest utilization and those with a Post-graduate degree the lowest. In British Columbia thepattern was not as clear. Males with a Post-graduate degree had the lowest utilization, but forfemales, those with less than Secondary schooling had the lowest. Females with no education hadthe highest average number of physician visits, but for males, the one year rates were fairlycomparable for all groups except those with Post-graduate qualifications.In Manitoba, the rates decreased with increased length of residence for most education groups.The exceptions were males with a Post-graduate degree and females with no education or with aBachelor’s degree. In British Columbia the rates increased across all groups over time.22Table 3.24 Physician claim number and age-standardized claims per person by education, sexand length of residence, ManitobaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Education  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesNone 872 5.6 784 4.3 1656 5.0 0.62 0.48 0.55Secondary, less 3728 6.1 2741 4.7 6469 5.4 0.67 0.51 0.59Trade, diploma 1213 4.6 1108 3.6 2321 4.1 0.51 0.40 0.45Bachelor’s 1099 5.2 923 3.5 2022 4.4 0.57 0.38 0.48Post-graduate 409 2.7 388 3.3 797 3.0 0.29 0.37 0.33FemalesNone 933 8.3 723 9.2 1656 8.9 0.65 0.71 0.69Secondary, less 6338 7.8 5832 7.1 12170 7.4 0.60 0.55 0.58Trade, diploma 2351 7.0 2334 6.1 4685 6.6 0.54 0.48 0.51Bachelor’s 1902 6.3 2033 6.5 3935 6.4 0.48 0.50 0.49Post-graduate 432 5.5 427 4.9 859 5.3 0.43 0.38 0.411 Relative to total age-standardized rate for other residents of Manitoba (males 9.1, females 12.9)Table 3.25 Physician claim number and age-standardized claims per person by education, sexand length of residence, British ColumbiaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Education  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesNone 8169 7.5 10590 9.0 18759 8.3 0.51 0.61 0.56Secondary, less 58090 7.3 84754 10.7 142844 9.0 0.49 0.72 0.61Trade, diploma 18671 7.2 27373 10.5 46044 8.8 0.48 0.71 0.59Bachelor’s 14511 6.6 23064 9.6 37575 8.1 0.44 0.65 0.54Post-graduate 5921 6.1 7467 8.1 13388 7.1 0.41 0.54 0.48FemalesNone 8279 14.6 11273 19.3 19552 16.9 0.69 0.91 0.80Secondary, less 114614 10.8 158718 15.3 273332 13.0 0.51 0.72 0.61Trade, diploma 41545 12.4 54400 15.5 95945 13.9 0.58 0.73 0.66Bachelor’s 30733 13.6 39286 15.2 70019 14.4 0.64 0.72 0.68Post-graduate 7228 10.2 9488 18.5 16716 14.3 0.48 0.88 0.681 Relative to total age-standardized rate for other residents of British Columbia (males 14.8, females 21.2)3.2.10 Years of schoolingBoth male and female immigrants in Manitoba who had no education utilized physicians themost, although males with 1-6 years of schooling had slightly higher rates than those men withno education during the 7-12 month period of residence (Table 3.26). The lowest physicianutilization rates were for men with 7-12 years of schooling and for women with 17 or more yearsof schooling.23Table 3.26 Physician claim number and age-standardized claims per person by school years, sexand length of residence, ManitobaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Years of school  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesNone 1326 7.2 872 4.6 2198 5.9 0.79 0.50 0.651-6 2685 5.7 2172 4.8 4857 5.3 0.63 0.52 0.587-12 1611 4.6 1406 3.2 3017 3.9 0.50 0.35 0.4313-16 828 5.0 710 4.2 1538 4.6 0.54 0.46 0.5017+ 872 5.6 784 4.3 1656 5.0 0.62 0.48 0.55FemalesNone 927 8.1 718 8.6 1645 8.5 0.62 0.67 0.661-6 1632 7.4 1313 6.9 2945 7.2 0.57 0.54 0.557-12 5140 8.0 5069 7.4 10209 7.7 0.62 0.57 0.6013-16 3244 7.3 3248 6.6 6492 7.0 0.57 0.51 0.5417+ 1013 5.4 1001 5.0 2014 5.2 0.41 0.39 0.401 Relative to total age-standardized rate for other residents of Manitoba (males 9.1, females 12.9)Table 3.27 Physician claim number and age-standardized claims per person by school years, sexand length of residence, British ColumbiaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Years of school  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesNone 8085 8.2 10519 10.1 18604 9.2 0.55 0.68 0.621-6 15370 7.9 22002 11.3 37372 9.6 0.53 0.76 0.657-12 44638 7.4 65179 10.8 109817 9.0 0.50 0.73 0.6113-16 25004 6.1 38662 9.4 63666 7.7 0.41 0.63 0.5217+ 12265 6.6 16886 8.9 29151 7.7 0.44 0.60 0.52FemalesNone 8226 19.1 11080 22.4 19306 20.7 0.90 1.06 0.981-6 24545 10.8 34963 16.5 59508 13.6 0.51 0.78 0.647-12 93746 11.1 128991 15.5 222737 13.2 0.52 0.73 0.6313-16 58290 11.4 76566 13.9 134856 12.6 0.54 0.66 0.6017+ 17592 14.4 21565 16.1 39157 15.2 0.68 0.76 0.721 Relative to total age-standardized rate for other residents of British Columbia (males 14.8, females 21.2)In British Columbia, men with 1-6 years of education had a higher average number of physicianvisits than male immigrants with other levels of education.  However, during the first six monthsof residence those with no education had the highest average number of visits (Table 3.27). Menwith higher levels of education (13 years or more) utilized physicians the least. For women, thehighest average number of visits were for women with no education and the lowest for womenwith 13-16 years of schooling, although women with 1-12 years of schooling had a lower rateduring the first six months of residence.24With the exception of female immigrants in British Columbia with no education during 7-12months residence, immigrants of all education levels visited physicians less than other residentsof Manitoba and British Columbia.3.3 Hospital dischargesOverall, the age-standardized hospital discharge rates for immigrants were substantially lowerthan those for other residents in both Manitoba and British Columbia (Tables 3.28, 3.29). Therelative risks (RR) indicate that the age-standardized rates for females were closer to the non-immigrants than were those of male immigrants (Manitoba RR - Males 0.37, Females 0.73;British Columbia RR - Males 0.38, Females 0.51). The hospitalization rates for immigrants inboth provinces increased with increasing length of residence. The rates for both immigrants andother residents tended to be lower in British Columbia than in Manitoba. The only exception wasfor male immigrants after 7-12 months residence.3.3.1 AgeTable 3.28 Hospital discharge number and rates (per 1,000) by age, sex and length of residence,ManitobaImmigrants Non-         0-6 Months  7-12 Months   0-12 Months Immig Relative rates1Age No.   Rate No. Rate No. Rate  Rate  0-6 M 7-12 M 0-12 MMales  0-14 22 62.7 21 61.3 43 62.0 108.4 0.58 0.57 0.5715-24 8 33.5 7 30.1 15 31.8 90.2 0.37 0.33 0.3525-34 20 44.6 23 53.6 43 49.0 107.9 0.41 0.50 0.4535-44 9 34.3 11 43.5 20 38.8 129.2 0.27 0.34 0.3045-54 7 71.5 14 148.9 21 109.5 176.8 0.40 0.84 0.6255-64 6 91.0 4 63.2 10 77.4 295.5 0.31 0.21 0.26     65+ 7 169.8 6 148.6 13 159.3 587.0 0.29 0.25 0.27Total-crude rate 79 52.5 86 59.1 165 55.7 185.5 0.28 0.32 0.30Total-stand rate 67.9 75.0 71.4 192.9 0.35 0.39 0.37Females  0-14 8 25.6 10 32.8 18 29.2 95.0 0.27 0.35 0.3115-24 44 141.2 94 310.4 138 224.6 275.9 0.51 1.13 0.8125-34 101 213.1 189 410.8 290 310.5 313.5 0.68 1.31 0.9935-44 39 146.8 48 184.8 87 165.6 204.3 0.72 0.90 0.8145-54 16 152.9 20 199.4 36 175.7 220.9 0.69 0.90 0.8055-64 13 161.2 6 76.8 19 119.7 295.2 0.55 0.26 0.41     65+ 16 285.9 19 346.2 35 315.8 467.2 0.61 0.74 0.68Total-crude rate 237 147.7 386 247.4 623 196.8 257.0 0.57 0.96 0.77Total-stand rate 150.7 218.1 183.9 250.7 0.60 0.87 0.731 Relative to agespecific and total rates for other residents of ManitobaMale immigrants had lower hospital discharge rates than non-immigra ts at all ages (Tables3.28, 3.29). Although female immigrants had lower rates than other provincial residents for theentire 0-12 month period, during the 7-12 month residence period female immigrants in25Manitoba aged 15-34 and in British Columbia aged 15-24 had higher rates. As noted below, thisis primarily due to hospitalizations for pregnancy related conditions.Table 3.29 Hospital discharge number and rates (per 1,000) by age, sex and length of residence,British ColumbiaImmigrants Non-         0-6 Months  7-12 Months   0-12 Months Immig Relative rates1Age No.   Rate No. Rate No. Rate  Rate  0-6 M 7-12 M 0-12 MMales  0-14 89 20.7 131 31.4 220 26.0 83.8 0.25 0.38 0.3115-24 64 24.1 101 40.0 165 31.9 71.5 0.34 0.56 0.4525-34 104 27.1 126 34.8 230 30.8 93.6 0.29 0.37 0.3335-44 63 16.1 115 30.5 178 23.2 104.5 0.15 0.29 0.2245-54 54 27.8 123 65.1 177 46.2 134.2 0.21 0.49 0.3455-64 57 57.5 147 154.7 204 105.0 238.4 0.24 0.65 0.44     65+ 88 137.0 166 273.2 254 203.2 465.1 0.29 0.59 0.44Total-crude rate 519 28.4 909 51.9 1428 39.9 159.7 0.18 0.32 0.25Total-stand rate 39.7 77.5 58.2 153.6 0.26 0.50 0.38Females  0-14 39 9.9 72 18.9 111 14.3 63.4 0.16 0.30 0.2315-24 335 104.0 642 209.9 977 155.6 175.1 0.59 1.20 0.8925-34 587 130.5 908 214.3 1495 171.1 266.7 0.49 0.80 0.6435-44 197 49.8 364 95.2 561 72.1 169.2 0.29 0.56 0.4345-54 87 50.1 139 83.0 226 66.2 158.5 0.32 0.52 0.4255-64 88 76.5 168 152.2 256 113.5 212.8 0.36 0.72 0.53     65+ 82 98.2 147 183.5 229 140.0 390.0 0.25 0.47 0.36Total-crude rate 1415 73.2 2440 131.8 3855 101.9 204.3 0.36 0.65 0.50Total-stand rate 69.7 127.6 98.0 192.9 0.36 0.66 0.511 Relative to age-specific and total rates for other residents of British Columbia3.3.2 DiagnosisAlthough when the hospital discharges were broken down by principal diagnosis the numberstended to be small, for most diagnostic groups the rates were lower for immigrants than for otherresidents (Tables 3.30, 3.31). The major exception to this was Pregnancy related conditions. Forwomen in Manitoba immigrants had comparable or higher Pregnancy rates than non-immigrantsat both 0-6 and 7-12 months while in British Columbia they were higher only in the latterresidency period. However, in both provinces there was a marked increase in hospitalizations forPregnancy after the women had been residents for 6 months.Immigrants in both provinces also had higher discharge rates than the general population fordisorders of the Nervous system or sensory organs during the 7-12 mon  period. The only otherdiagnoses for which Manitoba immigrants had similar or elevated rates compared to the generalpopulation occurred during their initial period of residence. They were Infectious diseases andInjuries and poisonings for females and Genitourinary disorders and Congenital abnormalities formales immigrants. However, the latter were based on only two hospitalizations. Male immigrantsin British Columbia also had slightly higher discharge rates than the remainder of the population26for Genitourinary conditions, but unlike in Manitoba, it occurred during the 7-12 month period ofresidence.Table 3.30 Hospital discharge number and age-standardized rate (per 1,000) by diagnosis, sexand length of residence, ManitobaImmigrants Non-         0-6 Months  7-12 Months   0-12 Months Immig Relative rates1Diagnosis No.     Rate No. Rate No.  Rate   Rate  0-6 M 7-12 M 0-12 MMalesInfectious 2 1.2 1 1.4 3 1.3 3.1 0.38 0.43 0.41Neoplasms 1 0.6 5 3.7 6 2.1 19.4 0.03 0.19 0.11Endocrine 1 0.3 0 0.0 1 0.2 3.3 0.11 0.00 0.05Blood 1 0.3 0 0.0 1 0.2 1.5 0.23 0.00 0.12Mental 2 1.0 1 0.7 3 0.8 5.9 0.17 0.11 0.14Nervous, sens 5 5.1 11 16.5 16 10.7 11.9 0.43 1.38 0.90Circulatory 8 13.8 6 7.2 14 10.5 23.6 0.58 0.30 0.45Respiratory 10 10.0 8 4.6 18 7.3 17.0 0.58 0.27 0.43Digestive 12 7.3 21 17.2 33 12.2 26.1 0.28 0.66 0.47Genitourinary 13 10.1 6 8.0 19 9.1 10.0 1.01 0.80 0.91Pregnancy 2 1.1 0 0.0 2 0.6Skin 2 0.7 5 2.5 7 1.6 9.7 0.07 0.26 0.16Musculoskeletal 2 0.9 2 0.7 4 0.8 10.7 0.08 0.07 0.08Congenital 2 1.2 1 0.4 3 0.8 1.1 1.03 0.32 0.68Perinatal 0 0.0 0 0.0 0 0.0 0.1 0.00 0.00 0.00Ill-defined 1 0.6 1 1.4 2 1.0 9.4 0.06 0.15 0.10Injuries, poison 8 5.2 4 2.2 12 3.8 14.7 0.35 0.15 0.25V codes 7 8.4 13 8.3 20 8.3 14.4 0.58 0.57 0.58Missing 0 0.0 0 0.0 0 0.0 10.8 0.00 0.00 0.00FemalesInfectious 4 3.7 3 1.0 7 2.4 3.3 1.15 0.31 0.74Neoplasms 17 12.3 16 12.3 33 12.3 21.0 0.59 0.59 0.59Endocrine 1 1.1 0 0.0 1 0.5 3.5 0.31 0.00 0.16Blood 0 0.0 1 0.3 1 0.2 1.6 0.00 0.21 0.10Mental 2 2.8 4 1.6 6 2.2 6.4 0.44 0.25 0.34Nervous, sens 4 3.5 13 19.1 17 11.2 13.5 0.26 1.42 0.83Circulatory 5 8.3 9 10.0 14 9.1 15.4 0.54 0.65 0.59Respiratory 6 5.2 10 8.4 16 6.8 13.7 0.38 0.61 0.50Digestive 24 19.4 21 19.2 45 19.3 25.9 0.75 0.74 0.75Genitourinary 21 15.5 30 21.7 51 18.5 22.9 0.68 0.95 0.81Pregnancy 120 47.6 240 94.7 360 70.8 46.9 1.02 2.02 1.51Skin 0 0.0 5 4.0 5 2.0 9.2 0.00 0.43 0.21Musculoskeletal 3 1.6 3 2.0 6 1.8 10.5 0.15 0.19 0.17Congenital 0 0.0 0 0.0 0 0.0 1.0 0.00 0.00 0.00Perinatal 0 0.0 0 0.0 0 0.0 0.0 0.00 0.00 0.00Ill-defined 4 4.4 6 7.4 10 5.9 10.0 0.44 0.74 0.59Injuries, poison 11 14.3 10 8.6 21 11.5 11.7 1.22 0.73 0.98V codes 13 10.4 14 7.4 27 8.9 17.5 0.60 0.42 0.51Other 0 0.0 0 0.0 0 0.0 16.9 0.00 0.00 0.001 Relative to diagnosis-specific age-standardized rates for other residents of Manitoba27Table 3.31 Hospital discharge number and age-standardized rate (per 1,000) by diagnosis, sexand length of residence, British ColumbiaImmigrants Non-         0-6 Months  7-12 Months   0-12 Months Immig Relative rates1Diagnosis No.     Rate No. Rate No.  Rate   Rate  0-6 M 7-12 M 0-12 MMalesInfectious 14 1.0 17 1.0 31 1.0 2.4 0.41 0.43 0.42Neoplasms 30 3.8 62 6.4 92 5.1 11.1 0.34 0.58 0.46Endocrine 5 0.5 11 1.2 16 0.8 2.7 0.20 0.44 0.32Blood 5 0.2 2 0.1 7 0.2 0.8 0.30 0.11 0.21Mental 12 0.6 14 0.9 26 0.8 6.1 0.10 0.15 0.12Nervous, sens 49 5.1 121 13.8 170 9.4 12.6 0.41 1.10 0.74Circulatory 41 3.9 98 11.0 139 7.4 20.1 0.19 0.55 0.37Respiratory 29 2.1 59 3.8 88 2.9 12.7 0.16 0.30 0.23Digestive 103 7.3 148 10.1 251 8.6 24.3 0.30 0.41 0.36Genitourinary 70 5.5 147 13.8 217 9.6 13.1 0.42 1.06 0.73Skin 11 0.6 12 0.8 23 0.7 2.0 0.28 0.40 0.34Musculoskeletal 31 1.5 44 2.6 75 2.0 11.0 0.13 0.23 0.18Congenital 12 0.6 18 0.9 30 0.7 1.3 0.44 0.69 0.56Perinatal 0.0 0.00 0.00 0.00Ill-defined 18 1.3 39 3.0 57 2.1 8.2 0.16 0.36 0.26Injuries, poison 65 4.2 88 6.0 153 5.1 14.9 0.28 0.40 0.34V codes 24 1.7 29 2.1 53 1.9 10.4 0.17 0.20 0.19FemalesInfectious 15 0.9 12 0.6 27 0.8 1.9 0.46 0.33 0.40Neoplasms 65 4.6 75 4.9 140 4.8 12.7 0.37 0.39 0.38Endocrine 12 1.0 21 1.7 33 1.3 2.8 0.36 0.59 0.48Blood 3 0.1 4 0.3 7 0.2 0.9 0.15 0.31 0.23Mental 29 1.4 23 1.2 52 1.3 6.9 0.20 0.17 0.19Nervous, sens 74 6.7 197 19.5 271 13.0 14.5 0.46 1.35 0.90Circulatory 29 2.8 40 3.4 69 3.1 12.7 0.22 0.27 0.24Respiratory 27 1.7 48 3.5 75 2.6 10.3 0.17 0.34 0.25Digestive 102 6.3 171 11.0 273 8.6 23.5 0.27 0.47 0.36Genitourinary 119 6.3 168 9.4 287 7.8 22.7 0.28 0.42 0.35Pregnancy 833 31.8 1462 58.9 2295 45.0 40.5 0.78 1.46 1.11Skin 7 0.4 6 0.3 13 0.3 1.7 0.24 0.16 0.20Musculoskeletal 18 1.1 46 3.4 64 2.2 9.6 0.11 0.36 0.23Congenital 3 0.3 9 0.5 12 0.4 1.1 0.31 0.46 0.38Perinatal 0.0 0.0 0.0 0.1 0.00 0.00 0.00Ill-defined 22 1.2 46 2.7 68 2.0 8.8 0.14 0.31 0.22Injuries, poison 24 1.2 56 3.5 80 2.3 10.9 0.11 0.32 0.21V codes 33 1.8 56 2.9 89 2.3 11.6 0.16 0.25 0.201 Relative to diagnosis-specific age-standardized rates for other residents of British Columbia283.3.3 ProcedureIn Manitoba the three most common procedures for male immigrants were Digestive, Eye andUrinary related (Table 3.32). For other Manitoba  males Eye procedures were ranked much lowerand Diagnostic and Therapeutic procedures were ranked second while procedures on theIntegumentary system were ranked third. The top three ranked procedures for female immigrantswere Obstetrical, Genital and Digestive related. These were also the top ranked procedures forother female residents of Manitoba, although Obstetrical procedures ranked third. There wereprocedures, particularly among females, that the immigrants had higher rates than the generalpopulation, however, most of these estimates were based on very small numbers and thus notvery reliable. Of the more common procedures, operations on the Eyes were concentrated in the7-12 month period for both males and females. Si ilarly, Obstetrical procedures were muchmore common in the 7-12 month residency period than in the 0-6 month period.Comparison of Manitoba and British Columbia results are complicated by the fact that a differentclassification system was used in the two provinces for the recording of procedures. Nonetheless,in British Columbia, as in Manitoba, the two most common procedures for immigrant men wereEye and Digestive related (Table 3.33). The third most common set of procedures for maleimmigrants in British Columbia, but not Manitoba, were the Diagnostic and Therapeuticprocedures. For other male British Columbians, Digestive, Diagnostic and Therapeutic andMusculoskeletal procedures were the three most common ones. For female immigrantsObstetrical procedures were the most common followed by Eye and Genital. The three mostcommon procedures for the general female population were Obstetrical, Diagnostic andTherapeutic, and Digestive. As in Manitoba, the Eye and Obstetrical procedures wereconcentrated in the 7-12 month residency period. For the majority of procedures, immigrants inBritish Columbia had lower rates than the general population. The exceptions for males wereEndocrine, Eye (7-12 months only) and Other, while for females the exceptions were Obstetrical(total and 7-12 months), Eye (total and 7-12 months) and Other.3.3.4 Visa categoryThere was not a consistent hospitalization pattern according to visa category (Table 3.34, 3.35).In British Columbia, Refugees had high hospitalization during the first year, but females on aFamily visa also had high rates. The lowest rates were for immigrants on an Economic-Businessvisa.In Manitoba, male Refugees also had the highest hospitalization rates, but immigrants on Othervisas had the lowest rates, although as in British Columbia, immigrants on an Economic-Business visa also had low rates. Female immigrants on Family and Economic-Skilled-Independent visas had the highest rates, while those on Other visas had the lowest. These patternsvaried somewhat by length of residence in Canada.29Table 3.32 Hospital discharge number and age-standardized rate (per 1,000) by procedure, sexand length of residence, ManitobaImmigrants Non-         0-6 Months  7-12 Months   0-12 Months Immig Relative rates1Procedure No.     Rate No. Rate No.  Rate   Rate  0-6 M 7-12 M 0-12 MMalesNervous 2 2.0 1 1.4 3 1.7 2.1 0.93 0.65 0.80Endocrine 0 0.0 0 0.0 0 0.0 0.2 0.00 0.00 0.00Eye 2 2.6 8 14.1 10 8.3 6.8 0.38 2.07 1.21Ear 3 2.5 3 2.3 6 2.4 2.8 0.88 0.82 0.85Nose, mouth, ph 6 2.9 11 6.9 17 4.8 7.5 0.38 0.92 0.64Respiratory 2 3.5 0 0.0 2 1.8 3.0 1.17 0.00 0.59Cardiovascular 1 1.3 2 2.7 3 2.0 8.0 0.16 0.34 0.25Hemic, lymph 1 0.6 0 0.0 1 0.3 1.2 0.51 0.00 0.26Digestive 9 5.1 20 16.4 29 10.7 28.2 0.18 0.58 0.38Urinary 9 12.0 0 0.0 9 6.1 5.9 2.03 0.00 1.03Genital 5 2.7 7 8.6 12 5.6 7.0 0.38 1.22 0.79Obstetrical 1 0.6 0 0.0 1 0.3 0.0 0.00 0.00 0.00Musculoskeletal 7 3.2 4 1.9 11 2.6 13.5 0.24 0.14 0.19Integumentary 2 0.7 10 5.3 12 2.9 15.5 0.04 0.34 0.19Diag, therapeut 8 7.6 3 3.3 11 5.5 19.2 0.40 0.17 0.29None 20 19.3 17 12.1 37 15.8 71.8 0.27 0.17 0.22FemalesNervous 0 0.0 4 3.2 4 1.6 2.4 0.00 1.33 0.65Endocrine 1 1.1 1 0.3 2 0.7 0.5 2.33 0.74 1.54Eye 2 2.1 8 15.6 10 8.8 8.2 0.26 1.90 1.07Ear 1 0.7 1 0.3 2 0.5 2.0 0.32 0.17 0.25Nose, mouth, ph 6 3.3 6 4.1 12 3.7 6.6 0.49 0.61 0.55Respiratory 1 2.2 4 5.9 5 4.0 2.0 1.09 2.93 2.00Cardiovascular 2 1.7 4 2.0 6 1.8 4.7 0.37 0.42 0.40Hemic, lymph 2 3.4 1 1.3 3 2.4 1.0 3.41 1.28 2.36Digestive 19 13.0 28 25.5 47 19.2 28.4 0.46 0.90 0.67Urinary 4 2.4 2 1.7 6 2.1 3.3 0.74 0.53 0.63Genital 56 25.9 67 28.3 123 27.1 28.4 0.91 1.00 0.95Obstetrical 49 19.2 125 50.5 174 34.6 22.4 0.86 2.26 1.55Musculoskeletal 6 6.5 9 8.2 15 7.3 11.6 0.56 0.71 0.63Integumentary 9 6.5 11 6.9 20 6.7 21.4 0.31 0.32 0.31Diag, therapeut 14 16.6 10 9.8 24 13.2 17.4 0.95 0.56 0.76None 65 46.2 105 54.4 170 50.2 90.4 0.51 0.60 0.561 Relative to procedure-specific age-standardized rates for other residents of Manitoba30Table 3.33 Hospital discharge number and age-standardized rate (per 1,000) by procedure, sexand length of residence, British ColumbiaImmigrants Non-         0-6 Months  7-12 Months   0-12 Months Immig Relative rates1Procedure No.     Rate No. Rate No.  Rate   Rate  0-6 M 7-12 M 0-12 MMalesDiag, therapeut 64 5.8 101 9.0 165 7.4 22.7 0.25 0.40 0.32Nervous 7 0.6 20 1.1 27 0.9 3.1 0.21 0.35 0.28Endocrine 3 0.1 2 0.2 5 0.1 0.1 1.13 1.27 1.19Eye 45 5.1 86 11.7 131 8.4 8.8 0.58 1.33 0.95Ear 11 0.7 30 1.9 41 1.3 2.4 0.28 0.77 0.52Nose, mouth, ph 29 1.5 75 4.2 104 2.8 8.2 0.19 0.51 0.34Respiratory 14 1.6 16 2.5 30 2.0 2.6 0.60 0.93 0.76Cardiovascular 17 1.5 60 6.4 77 3.9 8.8 0.17 0.73 0.44Hemic, lymph 1 0.0 4 0.2 5 0.1 0.6 0.08 0.29 0.18Digestive 93 7.0 129 9.5 222 8.2 20.6 0.34 0.46 0.40Urinary 37 2.6 79 5.9 116 4.2 5.9 0.44 1.00 0.72Genital 29 1.8 58 6.3 87 4.0 7.9 0.22 0.80 0.50Musculoskeletal 56 3.1 89 5.4 145 4.2 16.4 0.19 0.33 0.26Breast 1 0.1 1 0.0 2 0.1 0.3 0.30 0.15 0.23Skin, subcutan 11 0.7 15 0.8 26 0.7 3.1 0.21 0.25 0.23Other 2 0.2 1 0.2 3 0.2 0.2 1.24 1.05 1.15None 99 7.3 143 12.3 242 9.7 41.8 0.17 0.30 0.23FemalesDiag, therapeut 83 5.9 96 6.4 179 6.2 20.5 0.29 0.31 0.30Nervous 12 0.9 13 1.0 25 0.9 3.2 0.28 0.30 0.29Endocrine 4 0.2 6 0.3 10 0.3 0.3 0.63 1.00 0.81Eye 59 5.9 171 18.6 230 12.2 10.5 0.56 1.77 1.15Ear 14 0.7 27 1.3 41 1.0 1.9 0.38 0.70 0.54Nose, mouth, ph 23 1.1 53 2.7 76 1.9 7.6 0.14 0.36 0.25Respiratory 5 0.3 13 0.8 18 0.6 1.6 0.19 0.52 0.35Cardiovascular 9 0.8 20 1.5 29 1.2 4.8 0.16 0.32 0.24Hemic, lymph 2 0.1 4 0.4 6 0.2 0.6 0.14 0.66 0.40Digestive 124 7.5 154 9.7 278 8.6 20.1 0.37 0.48 0.43Urinary 23 1.3 38 2.6 61 1.9 5.1 0.26 0.50 0.38Genital 135 6.3 234 11.1 369 8.7 19.9 0.32 0.56 0.43Obstetrical 682 25.9 1230 49.5 1912 37.4 32.2 0.80 1.53 1.16Musculoskeletal 23 1.4 59 4.0 82 2.7 12.3 0.11 0.33 0.22Breast 25 1.6 29 1.7 54 1.6 5.4 0.29 0.31 0.30Skin, subcutan 9 0.5 16 0.8 25 0.6 2.9 0.17 0.27 0.22Other 3 0.2 3 0.2 6 0.2 0.2 1.11 1.11 1.11None 180 9.2 274 14.9 454 12.0 43.5 0.21 0.34 0.281 Relative to procedure-specific age-standardized rates for other residents of British Columbia31Table 3.34 Hospital discharge number and age-standardized rate (per 1,000) by visa category,sex and length of residence, ManitobaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Visa category  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesFamily 30 73.1 22 54.5 52 63.9 0.38 0.28 0.33Econ-Skill-Fam 15 56.5 22 71.1 37 63.8 0.29 0.37 0.33Econ-Skill-Ind 4 99.2 10 48.5 14 74.0 0.51 0.25 0.38Econ-Business 3 31.3 5 52.8 8 42.0 0.16 0.27 0.22Refugee 27 76.4 26 130.6 53 102.4 0.40 0.68 0.53Other 0 0.0 1 8.4 1 4.2 0.00 0.04 0.02FemalesFamily 137 207.7 243 308.0 380 257.1 0.83 1.23 1.03Econ-Skill-Fam 30 67.3 41 143.8 71 105.2 0.27 0.57 0.42Econ-Skill-Ind 27 390.4 17 66.8 44 233.3 1.56 0.27 0.93Econ-Business 6 66.9 16 170.0 22 117.9 0.27 0.68 0.47Refugee 29 124.4 60 193.5 89 158.4 0.50 0.77 0.63Other 8 36.1 9 41.8 17 38.9 0.14 0.17 0.161 Relative to total age-standardized rate for other residents of Manitoba (males 192.9, females 250.7)Table 3.35 Hospital discharge number and age-standardized rate (per 1,000) by visa category,sex and length of residence, British ColumbiaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Visa category  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesFamily 282 55.7 508 96.5 790 75.5 0.36 0.63 0.49Econ-Skill-Fam 88 128.3 123 51.0 211 91.8 0.84 0.33 0.60Econ-Skill-Ind 32 7.6 73 84.8 105 46.1 0.05 0.55 0.30Econ-Business 25 16.1 100 29.6 125 22.7 0.10 0.19 0.15Refugee 77 116.8 89 135.8 166 126.6 0.76 0.88 0.82Other 15 22.1 16 35.1 31 28.6 0.14 0.23 0.19FemalesFamily 827 107.8 1583 211.5 2410 158.3 0.56 1.10 0.82Econ-Skill-Fam 224 63.5 295 67.1 519 65.4 0.33 0.35 0.34Econ-Skill-Ind 91 20.1 169 130.7 260 71.2 0.10 0.68 0.37Econ-Business 70 28.6 139 63.3 209 45.9 0.15 0.33 0.24Refugee 86 116.7 151 198.8 237 157.3 0.60 1.03 0.82Other 117 96.7 103 84.0 220 90.8 0.50 0.44 0.471 Relative to total age-standardized rate for other residents of British Columbia (males 153.6, females 192.9)323.3.5 BirthplaceThere was substantial variation in hospital utilization by immigrants according to birthplace(Tables 3.36, 3.37). However, there was little consistency within-province by period ofresidence, or between provinces. This was possibly due to the small number of discharges forsome of the birthplace groups, particularly in Manitoba.Table 3.36 Hospital discharge number and age-standardized rate (per 1,000) by birthplace, sexand length of residence, ManitobaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Birthplace  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesUK & Ireland 6 154.0 9 134.3 15 143.9 0.80 0.70 0.75N & W Europe 2 11.8 3 18.2 5 15.0 0.06 0.09 0.08South Europe 3 22.0 13 142.9 16 81.9 0.11 0.74 0.42Eastern Europe 1 22.5 3 72.9 4 47.7 0.12 0.38 0.25Former USSR 3 42.0 3 42.7 6 42.3 0.22 0.22 0.22Middle East 14 168.0 7 229.4 21 203.0 0.87 1.19 1.05North Africa 0 0.0 2 342.7 2 171.3 0.00 1.78 0.89C & W Africa 1 22.4 0 0.0 1 11.4 0.12 0.00 0.06S  & E Africa 9 119.8 1 14.5 10 68.8 0.62 0.07 0.36South Asia 8 76.0 20 212.9 28 142.7 0.39 1.10 0.74Northeast Asia 9 69.4 5 25.3 14 47.5 0.36 0.13 0.25Southeast Asia 12 57.3 10 52.8 22 54.9 0.30 0.27 0.28North America 2 42.7 1 16.5 3 29.7 0.22 0.09 0.15Caribbean 0 0.0 5 175.6 5 87.8 0.00 0.91 0.46Central America 7 159.4 3 61.4 10 110.5 0.83 0.32 0.57South America 2 55.3 1 36.9 3 46.5 0.29 0.19 0.24Oceania 0 0.0 0 0.0 0 0.0 0.00 0.00 0.00FemalesUK & Ireland 4 44.3 13 171.3 17 108.3 0.18 0.68 0.43N & W Europe 8 169.1 12 248.8 20 205.8 0.67 0.99 0.82South Europe 17 80.5 42 186.8 59 133.0 0.32 0.75 0.53Eastern Europe 9 125.6 14 301.9 23 214.1 0.50 1.20 0.85Former USSR 18 340.4 10 109.3 28 225.1 1.36 0.44 0.90Middle East 10 186.4 10 336.7 20 261.7 0.74 1.34 1.04North Africa 0 0.0 1 52.2 1 24.5 0.00 0.21 0.10C & W Africa 3 173.8 7 387.0 10 273.6 0.69 1.54 1.09S  & E Africa 13 102.2 17 175.2 30 137.1 0.41 0.70 0.55South Asia 45 267.8 74 361.7 119 313.2 1.07 1.44 1.25Northeast Asia 28 105.8 22 59.3 50 83.0 0.42 0.24 0.33Southeast Asia 43 86.0 109 194.9 152 139.8 0.34 0.78 0.56North America 18 333.8 14 204.8 32 269.9 1.33 0.82 1.08Caribbean 6 137.1 4 272.0 10 189.6 0.55 1.09 0.76Central America 8 150.6 18 350.1 26 250.2 0.60 1.40 1.00South America 6 88.3 17 454.0 23 262.2 0.35 1.81 1.05Oceania 1 44.7 2 196.7 3 120.7 0.18 0.78 0.481 Relative to total age-standardized rate for other residents of Manitoba (males 192.9, females 250.7)33In Manitoba, overall in the first year, only men born in the Middle East had higher hospitalizationrates than the general Manitoba male population, although those born in North Africa and SouthAsia did have higher rates for the 7-12 month residency period. For females, numerous groupshad comparable or higher rates than other Manitoba females (Middle East, Central and WestAfrica, South Asia, North America, Central America and South America).Table 3.37 Hospital discharge number and age-standardized rate (per 1,000) by birthplace, sexand length of residence, British ColumbiaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Birthplace  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesUK & Ireland 33 68.4 39 127.9 72 97.4 0.45 0.83 0.63N & W Europe 120 58.5 253 126.9 373 91.5 0.38 0.83 0.60South Europe 125 22.0 249 42.3 374 32.0 0.14 0.28 0.21Eastern Europe 65 58.2 104 120.5 169 88.2 0.38 0.78 0.57Former USSR 23 72.8 36 130.8 59 100.1 0.47 0.85 0.65Middle East 8 105.0 9 155.8 17 130.7 0.68 1.01 0.85North Africa 9 269.4 9 52.6 18 160.1 1.75 0.34 1.04C & W Africa 7 64.9 12 286.2 19 174.0 0.42 1.86 1.13S  & E Africa 8 73.8 23 117.6 31 95.4 0.48 0.77 0.62South Asia 7 16.0 10 30.0 17 22.7 0.10 0.20 0.15Northeast Asia 29 55.8 32 79.9 61 67.7 0.36 0.52 0.44Southeast Asia 13 42.7 17 103.6 30 73.1 0.28 0.67 0.48North America 20 183.4 21 152.6 41 170.6 1.19 0.99 1.11Caribbean 32 47.4 70 144.9 102 94.6 0.31 0.94 0.62Central America 2 21.2 2 9.4 4 15.2 0.14 0.06 0.10South America 7 79.8 3 49.1 10 65.3 0.52 0.32 0.43Oceania 11 27.5 20 111.1 31 68.2 0.18 0.72 0.44FemalesUK & Ireland 43 89.9 48 115.4 91 102.3 0.47 0.60 0.53N & W Europe 319 98.4 772 243.6 1091 169.1 0.51 1.26 0.88South Europe 427 41.0 715 70.7 1142 55.6 0.21 0.37 0.29Eastern Europe 200 85.2 315 158.6 515 120.7 0.44 0.82 0.63Former USSR 82 197.7 59 164.6 141 181.9 1.02 0.85 0.94Middle East 8 91.8 10 137.8 18 113.3 0.48 0.71 0.59North Africa 20 109.0 25 199.8 45 152.3 0.56 1.04 0.79C & W Africa 15 94.3 15 148.8 30 121.4 0.49 0.77 0.63S  & E Africa 26 64.4 45 172.4 71 114.7 0.33 0.89 0.59South Asia 39 94.7 47 123.4 86 109.1 0.49 0.64 0.57Northeast Asia 59 115.6 78 134.5 137 125.6 0.60 0.70 0.65Southeast Asia 38 96.8 57 187.0 95 140.3 0.50 0.97 0.73North America 40 137.5 61 200.8 101 168.1 0.71 1.04 0.87Caribbean 42 57.4 110 205.0 152 129.5 0.30 1.06 0.67Central America 7 196.5 16 418.2 23 305.4 1.02 2.17 1.58South America 11 126.6 17 202.2 28 163.6 0.66 1.05 0.85Oceania 39 92.6 50 150.7 89 121.4 0.48 0.78 0.638271 Relative to total age-standardized rate for other residents of British Columbia (males 153.6, females 192.9)34In British Columbia, male immigrants from Central and West Africa had the highesthospitalization rates and those from Central America the lowest. In contrast, females born inCentral America had the highest hospitalization rates, while those born in Southern Europe hadthe lowest. Males born in North Africa and in North America were the only other groups to havefirst year hospitalization rates that were higher than other males resident in British Columbia,although some other male and female groups did have higher rates for one of the two residenceperiods.3.3.6 LanguageIn both provinces there were very few immigrants who spoke only French or English and French.In Manitoba, immigrants who did not speak one of Canada’s two official languages tended tohave higher hospitalization rates than did those immigrants who spoke English only (Tables3.38, 3.39).  The only exception was for male immigrants who had resided in Manitoba for 0-6months. In British Columbia the pattern was not as consistent. As in Manitoba, females who didnot speak English or French tended to utilize hospitals more than those who spoke English only,although not during the first six months of residence. In contrast, males who spoke English onlyhad comparable hospitalization rates to those men who spoke neither English nor French at 7-12months of residence, but had higher rates during the first six months of residency in BritishColumbia.In Manitoba, all immigrants, regardless of the language they spoke, had lower hospitalizationrates than the general Manitoba population. This was also true in British Columbia with theexception of females who only spoke French and who had been residents for 7-12 months.Table 3.38 Hospital discharge number and age-standardized rate (per 1,000) by Canadianlanguage spoken, sex and length of residence, ManitobaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Language  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesEnglish 36 72.6 37 55.4 73 64.4 0.38 0.29 0.33French 0 0.0 1 56.4 1 28.2 0.00 0.29 0.15English, French 1 14.2 4 106.9 5 60.5 0.07 0.55 0.31Neither 42 69.5 44 85.3 86 77.1 0.36 0.44 0.40FemalesEnglish 128 147.4 202 221.2 330 183.6 0.59 0.88 0.73French 1 41.4 3 202.2 4 120.9 0.17 0.81 0.48English, French 2 42.8 2 45.4 4 44.0 0.17 0.18 0.18Neither 106 162.6 179 248.8 285 204.8 0.65 0.99 0.821 Relative to total age-standardized rate for other residents of Manitoba (males 192.9, females 250.7)35Table 3.39 Hospital discharge number and age-standardized rate (per 1,000) by Canadianlanguage spoken, sex and length of residence, British ColumbiaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Language  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesEnglish 248 43.3 366 79.4 614 60.9 0.28 0.52 0.40French 3 44.0 3 51.2 6 47.8 0.29 0.33 0.31English, French 5 11.3 9 138.2 14 74.6 0.07 0.90 0.49Neither 263 37.4 531 79.9 794 58.2 0.24 0.52 0.38FemalesEnglish 774 80.9 971 109.9 1745 95.0 0.42 0.57 0.49French 9 127.1 19 207.6 28 167.3 0.66 1.08 0.87English, French 9 99.9 26 145.0 35 121.1 0.52 0.75 0.63Neither 623 64.1 1424 150.8 2047 106.7 0.33 0.78 0.551 Relative to total age-standardized rate for other residents of British Columbia (males 153.6, females 192.9)3.3.7 Medical profile assessmentMale and female immigrants in British Columbia and female immigrants in Manitoba who had amedical condition had substantially higher hospitalization rates than did those immigrants whodid not have a condition (Table 3.40, 3.41). Immigrant men in Manitoba with a condition onlyhad higher hospitalization rates during the early period of residence, however, the estimates werebased on small numbers. Only female immigrants who had been resident in Manitoba for 7-12months had utilization rates that were higher than those of other Manitoba women.Table 3.40 Hospital discharge number and age-standardized rate (per 1,000) by medical profileassessment, sex and length of residence, ManitobaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Assessment  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesNo condition 75 67.0 83 77.9 158 72.3 0.35 0.40 0.38Condition 4 75.5 3 45.6 7 60.6 0.39 0.24 0.31FemalesNo condition 220 146.6 360 208.0 580 176.8 0.58 0.83 0.71Condition 17 206.0 26 321.4 43 263.7 0.82 1.28 1.051 Relative to total age-standardized rate for other residents of Manitoba (males 192.9, females 250.7)36Table 3.41 Hospital discharge number and age-standardized rate (per 1,000) by medical profileassessment, sex and length of residence, British ColumbiaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Assessment  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesNo condition 467 37.8 844 75.8 1311 56.3 0.25 0.49 0.37Condition 52 90.5 65 116.5 117 103.4 0.59 0.76 0.67FemalesNo condition 1296 65.9 2283 124.2 3579 94.4 0.34 0.64 0.49Condition 119 135.8 157 176.9 276 155.7 0.70 0.92 0.811 Relative to total age-standardized rate for other residents of British Columbia (males 153.6, females 192.9)3.3.8 Conditions of landingIn Manitoba, over the first year immigrants who had an imposed medical condition of landinghad substantially higher hospitalization rates than did those immigrants who had no condition(Table 3.42). However, the pattern was not consistent over the two periods of residence. Formales this was only true during the first six months of residence and for females it was only trueduring the second six months of residence. With the exception of female immigrants resident inManitoba for 7-12 months, immigrants, regardless of the conditions imposed, had lowerhospitalization rates than other Manitobans.Table 3.42 Hospital discharge number and age-standardized rate (per 1,000) by conditions oflanding imposed, sex and length of residence, ManitobaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Conditions  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesNone 66 58.1 76 73.5 142 65.6 0.30 0.38 0.34Medical 12 158.7 8 68.1 20 113.3 0.82 0.35 0.59Other 1 16.1 2 41.2 3 28.3 0.08 0.21 0.15FemalesNone 207 150.7 337 210.6 544 180.3 0.60 0.84 0.72Medical 13 128.9 31 305.5 44 216.6 0.51 1.22 0.86Other 17 175.8 18 176.5 35 176.6 0.70 0.70 0.701 Relative to total age-standardized rate for other residents of Manitoba (males 192.9, females 250.7)In British Columbia (Table 3.43) there was no clear pattern of hospital utilization according toconditions of landing. Female immigrants with a medical condition of landing did have slightlyhigher utilization rates overall and during the 7-12 month period. Male immigrants with animposed medical condition had higher rates during the 7-12 month period but not overall.37In both Manitoba and British Columbia, immigrants with Other conditions of landing utilizedhospitals the least.Table 3.43 Hospital discharge number and age-standardized rate (per 1,000) by conditions oflanding imposed, sex and length of residence, British ColumbiaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Conditions  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesNone 451 43.4 751 84.5 1202 63.4 0.28 0.55 0.41Medical 55 33.0 111 90.7 166 61.0 0.21 0.59 0.40Other 13 19.2 47 22.6 60 20.9 0.13 0.15 0.14FemalesNone 1253 70.7 2091 130.5 3344 99.9 0.37 0.68 0.52Medical 103 70.1 167 138.1 270 103.2 0.36 0.72 0.54Other 59 26.5 182 82.0 241 53.8 0.14 0.42 0.281 Relative to total age-standardized rate for other residents of British Columbia (males 153.6, females 192.9)3.3.9 Marital statusAmong Manitoba male immigrants, only the single and married had enough numbers in order tomake a meaningful comparison. Single men had the highest hospitalization rates over the firstyear but this resulted from the high rates during the first six months of residence (Table 3.44).Table 3.44 Hospital discharge number and age-standardized rate (per 1,000) by marital status,sex and length of residence, ManitobaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Marital status  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesSingle 41 136.1 36 41.3 77 88.8 0.71 0.21 0.46Married 31 40.1 49 65.2 80 52.5 0.21 0.34 0.27Widowed 4 65.4 1 17.5 5 42.3 0.34 0.09 0.22Divorced 3 120.6 0 0.0 3 63.8 0.63 0.00 0.33Separated  0 0.0 0 0.0  0 0.0 0.00 0.00 0.00FemalesSingle 46 52.4 57 80.0 103 66.0 0.21 0.32 0.26Married 157 143.1 303 254.0 460 197.9 0.57 1.01 0.79Widowed 23 842.2 21 810.1 44 826.4 3.36 3.23 3.30Divorced 10 406.9 2 64.3 12 236.0 1.62 0.26 0.94Separated 1 35.0 3 140.4 4 80.1 0.14 0.56 0.321 Relative to total age-standardized rate for other residents of Manitoba (males 192.9, females 250.7)38During the 7-12 month period, married men had higher rates. Both married and single males hadlower hospitalization rates than the general Manitoba male population. For females, marriedimmigrants had substantially higher hospitalization rates than single immigrant women in bothperiods of residence. This is no doubt partly due to the greater number of pregnancy relatedhospitalizations among married women. In the 7-12 month period their hospitalization rate wascomparable to that of other Manitoba women. Widowed immigrants had an exceptionally highhospitalization rate. Their rate was more than three times higher than that of other Manitobawomen.In British Columbia, single males had higher hospitalization rates than married males in bothperiods of residence, but the reverse was found for females (Tabl  3.45). For both men andwomen the widowed had the highest hospitalization rates during their first year, however, only inthe 7-12 month period were the rates higher than those for other British Columbia residents. Therates for widowed female immigrants in British Columbia were substantially lower than those oftheir counterparts in Manitoba.Table 3.45 Hospital discharge number and age-standardized rate (per 1,000) by marital status,sex and length of residence, British ColumbiaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Marital status  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesSingle 173 79.4 265 117.5 438 97.9 0.52 0.76 0.64Married 322 35.3 595 68.5 917 51.5 0.23 0.45 0.34Widowed 15 61.6 41 172.0 56 115.7 0.40 1.12 0.75Divorced 8 100.9 7 40.7 15 74.3 0.66 0.27 0.48Separated 1 29.6 1 18.4 2 25.9 0.19 0.12 0.17FemalesSingle 241 80.6 355 93.5 596 87.0 0.42 0.48 0.45Married 1079 85.2 1889 163.2 2968 123.3 0.44 0.85 0.64Widowed 70 87.3 149 198.8 219 142.7 0.45 1.03 0.74Divorced 20 53.8 33 89.3 53 71.1 0.28 0.46 0.37Separated 5 38.7 14 92.4 19 65.6 0.20 0.48 0.341 Relative to total age-standardized rate for other residents of British Columbia (males 153.6, females 192.9)3.3.10 EducationMale immigrants in Manitoba with no educational qualifications had the lowest hospitalutilization rates while those with less than Secondary school qualifications had the highest(Table 3.46).  In contrast, females with no educational qualifications had the highest rate duringthe first year and those with a post-graduate degree the lowest. Only female immigrants with noeducational qualifications had hospitalization rates higher than the general Manitoba femalepopulation. It should be noted, however, that the results for both male and female immigrantswith no educational qualifications are based on small numbers.39Table 3.46 Hospital discharge number and age-standardized rate (per 1,000) by education, sexand length of residence, ManitobaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Education  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesNone 10 15.3 6 9.4 16 12.4 0.08 0.05 0.06Secondary, less 44 72.1 45 85.9 89 78.8 0.37 0.45 0.41Trade, diploma 15 54.7 23 56.9 38 55.8 0.28 0.30 0.29Bachelor’s 7 48.3 7 36.4 14 43.0 0.25 0.19 0.22Post-graduate 3 27.7 5 61.4 8 44.9 0.14 0.32 0.23FemalesNone 6 138.7 9 411.0 15 271.7 0.55 1.64 1.08Secondary, less 113 149.0 190 223.4 303 185.7 0.59 0.89 0.74Trade, diploma 56 229.1 104 202.4 160 216.8 0.91 0.81 0.87Bachelor’s 53 136.8 69 140.8 122 138.6 0.55 0.56 0.55Post-graduate 9 78.2 14 91.3 23 84.3 0.31 0.36 0.341 Relative to total age-standardized rate for other residents of Manitoba (males 192.9, females 250.7)In British Columbia male immigrants with no formal education qualifications, less thanSecondary or with a Trade or Diploma had comparable hospitalization rates for the first year, andthey were higher than those with higher levels of education (Table 3.47). Within the twocategories of residence the ranking of education groups varied considerably. For example, duringthe first six months of residence, men with a Trade or Diploma had the lowest hospitalizationrates and those with no qualifications or with a post-graduate degree had the highest.Table 3.47 Hospital discharge number and age-standardized rate (per 1,000) by education, sexand length of residence, British ColumbiaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Education  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesNone 53 57.4 68 62.8 121 60.1 0.37 0.41 0.39Secondary, less 308 41.5 548 81.7 856 61.1 0.27 0.53 0.40Trade, diploma 77 27.5 160 105.4 237 66.0 0.18 0.69 0.43Bachelor’s 49 29.2 107 62.2 156 45.3 0.19 0.41 0.30Post-graduate 32 55.7 26 39.0 58 47.5 0.36 0.25 0.31FemalesNone 46 92.4 63 224.0 109 156.7 0.48 1.16 0.81Secondary, less 733 67.0 1414 133.1 2147 99.3 0.35 0.69 0.51Trade, diploma 312 72.6 518 117.1 830 94.3 0.38 0.61 0.49Bachelor’s 271 76.3 373 141.6 644 108.0 0.40 0.73 0.56Post-graduate 53 75.9 72 153.6 125 114.3 0.39 0.80 0.591 Relative to total age-standardized rate for other residents of British Columbia (males 153.6, females 192.9)40Female immigrants with no qualifications had the highest hospitalization rate, while those with aTrade or Diploma had the lowest. The exception to this was during the 0-6 mo ths residencyperiod when women with less than Secondary had the lowest rates. Only women immigrants withno qualifications and who had resided in British Columbia for 7-12 months had hospitalizationrates higher than the general female population.3.3.11 Years of schoolingIn Manitoba, male immigrants with no schooling had the lowest hospital utilization rates, whilethose with 7-12 years of education had the highest, followed closely by those with 1-6 years ofschooling (Table 3.48). The latter had the highest rate during the first six months of residence.Unlike males, females with no schooling had the highest hospitalization rates during the firstyear. This resulted from their excessive rates in the 7-12 months period of residence. Thesewomen, as well as those with 7-12 years of schooling and 7-12 months of residency, were theonly immigrants to have higher hospitalization rates than the remainder of the Manitobapopulation. Women with 17 or more years of education utilized hospitals the least.Among male immigrants in British Columbia there tended to be a fairly clear gradient, ofdecreasing hospital utilization with increasing years of schooling (Table 3.49). Although femaleswith no formal education had the highest utilization rates, the lowest rates occurred amongwomen with 1-6 and 13-16 years of schooling. The immigrant women with no schooling werealso the only ones to have a higher 0-12 month hospitalization rate than the general femalepopulation in British Columbia.Table 3.48 Hospital discharge number and age-standardized rate (per 1,000) by school years, sexand length of residence, ManitobaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Years of school  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesNone 10 15.4 6 9.5 16 12.5 0.08 0.05 0.061-6 19 101.0 17 38.8 36 70.0 0.52 0.20 0.367-12 30 69.8 33 83.9 63 76.7 0.36 0.44 0.4013-16 15 56.6 20 46.6 35 52.0 0.29 0.24 0.2717+ 5 25.2 10 49.6 15 37.2 0.13 0.26 0.19FemalesNone 6 138.7 9 354.8 15 243.6 0.55 1.42 0.971-6 22 197.4 26 202.1 48 200.2 0.79 0.81 0.807-12 104 167.4 190 255.9 294 211.0 0.67 1.02 0.8413-16 80 194.4 126 166.7 206 180.8 0.78 0.67 0.7217+ 25 106.1 35 138.4 60 123.7 0.42 0.55 0.491 Relative to total age-standardized rate for other residents of Manitoba (males 192.9, females 250.7)41Table 3.49 Hospital discharge number and age-standardized rate (per 1,000) by school years, sexand length of residence, British ColumbiaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Years of school  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesNone 53 61.3 67 106.0 120 84.0 0.40 0.69 0.551-6 85 45.8 161 83.2 246 64.2 0.30 0.54 0.427-12 218 40.2 403 84.6 621 61.8 0.26 0.55 0.4013-16 104 32.8 224 75.0 328 53.5 0.21 0.49 0.3517+ 59 43.3 54 31.3 113 37.5 0.28 0.20 0.24FemalesNone 46 121.5 62 311.1 108 213.8 0.63 1.61 1.111-6 93 57.1 225 137.8 318 96.7 0.30 0.71 0.507-12 664 70.0 1234 136.0 1898 102.2 0.36 0.70 0.5313-16 480 80.5 735 113.4 1215 96.5 0.42 0.59 0.5017+ 132 76.8 184 134.5 316 104.8 0.40 0.70 0.541 Relative to total age-standardized rate for other residents of British Columbia (males 153.6, females 192.9)3.4 Communicable diseasesThe most common communicable disease among the new immigrants in Manitoba was HepatitisB. Their age-standardized rates were substantially higher than those of other Manitobans (Table3.50). Although based on small numbers, the rates among immigrants for tuberculosis, malariaand rubella (males only) were also higher than those for the general Manitoba population, whilethose for sexually transmitted diseases (STDs) and Other communicable disease were lower thanthose for other Manitobans.Table 3.50 Communicable diseases number and age-standardized incidence rates (per 100,000)by sex, ManitobaImmigrants Non-immigrantsMales Females Males Females Relative rates1Age No. Rate No. Rate No. Rate No. Rate Males FemalesTuberculosis 3 207.8 4 112.9 43 8.0 50 8.7 26.0 13.0Rubella 2 56.8 2 64.2 1 0.2 - - 294.7 -Hepatitis B 10 417.6 21 522.3 59 10.7 46 8.1 39.0 64.5Malaria 4 141.3 1 16.7 3 0.6 3 0.6 238.3 29.2STDs 5 114.4 10 192.5 961 164.5 2175 377.1 0.7 0.5Other 1 17.8 2 53.9 790 133.7 850 146.9 0.1 0.43.5 CancerThe number of incident cancer cases among the newly arrived immigrants was small (Table3.51). Although the rates for malignant neoplasms were lower than those for all Manitobans,those for benign and in situ neoplasms were higher, particularly among males. Of concern is the42fact that of the 8 malignant cases, 7 were diagnosed within the first six months of residence,suggesting they may have been missed by the screening process.Table 3.51 Cancer incidence number and age-standardized rate (per 100,000) by type, sex andlength of residence, ManitobaLength of residence    0-6 Months  7-12 Months       0-12 Months Relative rates1Type  No. Rate     No.    Rate No.  Rate  0-6 M 7-12 M 0-12 MMalesMalignant 3 242.9 0 0.00 3 123.1 0.70 0.00 0.35Benign & in situ 3 212.6 0 0.00 3 107.6 6.21 0.00 3.14FemalesMalignant 4 266.7 1 111.4 5 189.9 0.94 0.39 0.67Benign & in situ 2 130.7 0 0.00 2 66.1 2.07 0.00 1.05434. Discussion and ConclusionsThis pilot study has examined the feasibility of linking CIC’s landing file to provincialadministrative and health data sets in order to determine if these data sets can be used to evaluateCIC’s medical screening program and to define the health status of immigrants to Canada. Theresults of the study suggest that these are achievable goals.Over 80% of immigrants who landed in 1995 or 1996 and whose stated intended destination wasManitoba (84.5%) or British Columbia (81.1%) were linked to the provincial populationregistration files. The landing files provided by CIC contained records only for those people whoindicated that their intended destination was Manitoba or British Columbia. The percentagelinked would likely be higher if one were to use the number of immigrants arriving in theprovince as the denominator, as opposed to those who intended to go. Based on the informationcontained in the landing file there is no accurate way of assessing the quality of the recordlinkage as it is not possible to identify people who changed their minds and decided to settle inother provinces. Thus, we do not know how many people who arrived in Manitoba and BritishColumbia did not link due only to errors in the quality of the recorded information. However,many of the people who did not link were in family units, suggesting that the unsuccessfullinkage was not because of poor data quality, but because they settled in other provinces. Thisissue could have been examined by linking those immigrants whose intended destination wasManitoba, but who did not link to the Manitoba registration file to the British Columbia LinkageCoordinating file.Not all new immigrants to Manitoba and British Columbia would have been included in thisstudy, as some may initially have indicated they intended to reside in a different province andtherefore would not have been included in the files provided by CIC. Although it would increasethe time and expense of record linkage, the latter could be included if the file provided by CICincluded all immigrants to Canada, regardless of their intended province of residence.The percentage of records linked varied considerably by demographic and socioeconomiccharacteristic. For example, in Manitoba the percentage linked varied from 62% for immigrantsborn in the Middle East to 100% for those born in Oceania, while in British Columbia it rangedfrom 55% for those born in North Africa to 89% for immigrants born in Southern Europe.Differences of over 20% were also found for various visa categories. In order to be eligible forimmigration to Canada, prospective immigrants have to achieve a high enough score on a pointsystem based on various factors, including province of destination. It may therefore be observedthat for some groups, large proportions are not going to their intended province of residence.Compared to the general population in Manitoba or British Columbia, the physician visitationrates were approximately 40% lower among immigrants during their first year of residence inCanada. For males, the hospitalization rate was approximately 60% lower while for females itwas 50% lower in British Columbia, but only 25% lower in Manitoba. These findings wouldsuggest that new immigrants are healthy and therefore are using medical services less, and as44such, provide support for the efficacy of CIC’s medical screening process. Alternatively, it maybe that new immigrants have a lower utilization of medical services because they are facingbarriers in accessing the medical system. Such barriers would include lack of information aboutavailable services or language and cultural barriers.While overall the utilization of physician services and hospitals was lower among the newlyarrived immigrants than the general population, for various specific conditions and proceduresthey did have higher rates. For physician visits but not hospitalizations, male immigrants hadsubstantially higher utilization rates than other Manitoba males for Infectious and parasiticdiseases. For females, although the rates for Infectious and parasitic diseases were comparable toother Manitoba women, the immigrant / Manitoba ratio was one of the highest of all diagnosticgroupings. This was also reflected in the Communicable Disease database, which showedimmigrants had higher rates of tuberculosis, rubella, hepatitis B, and malaria. The mostconsistent finding was the high utilization of medical services by the immigrant women forpregnancy related conditions. The rates were particularly high in the second six months ofresidence. Immigrants also tended to have high rates of eye surgery. Although based on a smallnumber of cases, linkage of the CIC landing file to the Manitoba Cancer Registry suggests thatrelative to the general Manitoba population the new immigrants have a high incidence of benignneoplasms. Although more intensive screening by CIC is unlikely to have an effect on the highimmigrant pregnancy rate, it may well identify more potential immigrants with such conditionsas infectious and parasitic diseases, eye disorders, and benign and in situ neoplasms.The utilization of medical services by immigrants varied substantially according to theirdemographic and socioeconomic characteristics and their and existing medical conditions. Forexample, in both Manitoba and British Columbia there were large variations in physician andhospital utilization according to region of birth, although the patterns were not similar betweenthe two provinces. Immigrants on a Refugee visa or a Family visa tended to utilize physiciansand hospitals the most, while those on an Economic-Business visa tended to utilize them theleast. Immigrants whose medical profile assessment indicated that they had a medical conditionor who had a medical condition of landing imposed also tended to utilize physicians andhospitals to a greater degree than other immigrants. Analyses of the utilization of medicalservices by immigrant characteristics serves two purposes. First, it provides CIC with profiles ofhigh users of medical services which could be useful for improving medical screeningprocedures. Secondly, such profiles are of value to service providers as it allows them to developprograms and services targeted to high risk groups.The pattern of medical service use by immigrants was often different between Manitoba andBritish Columbia. For example, physician utilization rates were lower in Manitoba than in BritishColumbia, while the reverse was true for hospitalizations. It may well be that immigrants indifferent provinces utilize medical services differently. However, it may also be a reflection ofthe differences in what is captured in each of the provincial databases. It was beyond scope ofthis pilot study to address this issue. The differences may also be due to the relatively smallnumber of immigrants in Manitoba. Ideally, more provinces would be included in such analysesin order to establish a more definitive picture of the utilization of medical services by recentlyarrived immigrants.45In conclusion, this pilot study has demonstrated the feasibility of linking CIC’s landing file to theadministrative health databases that are maintained within individual provinces. Furthermore,these databases can be used to provide not only an assessment of CIC medical screening process,but to provide information on the health status and medical service requirements of immigrants.Such information could be of great value to provincial governments in developing health policy,programs and services for immigrants. This pilot study was constrained to some extent by thefact that the study cohort consisted only of landings for a two-year period and that the immigrantswere only followed up for one year. If the immigrant cohort was expanded to include landings foradditional years, or if the data from several provinces were combined, much more stableestimates could be derived for the hospital, communicable disease and cancer databases.  Withmore years of follow-up, it would in addition be possible to provide information on the morelong-term health status and service utilization of immigrants to Canada.46AppendicesAppendix I.  Variable recodingI.1 Visa categoryThe various visa categories used by CIC were aggregated into six groups. These are shown inAppendix Table I.1.Table I.1 Aggregation of visa categoriesVisa Groups Visa CategoriesFamily 10-18, 41, 42Economic-Skilled-Family 40, 43-46Economic-Skilled-Independent 60, 61, 65Economic-Business 50, 56, 90-93Refugee 20-29, 31-34, 37, 47-49, 52, 54, 55, 80, 86-89, 94, 95Other 30, 35, 36, 67, 96-9947I.2 Country of birthTable I.2 Regional aggregation of country of birthUnited Kingdom & Ireland Latvia Djibouti CaymanChannel Islands Lithuania Eritrea CubaEngland, Isle of Man Moldova Ethiopia DominicaIreland Russia Kenya Dominican RepNorthern Ireland Tadjikistan Lesotho GrenadaScotland Turkmenistan Madagascar GuadeloupeWales Ukraine Malawi HaitiNorth & West Europe USSR Mauritius JamaicaAustria Uzbekistan Mozambique St. Kitts & NevisBelgium Middle East Namibia St. LuciaDenmark, Faroe Is Bahrain Rwanda St. VincentFinland Iran Seychelles Trinidad, TobagoFrance Iraq Somalia Central AmericaGermany Israel South Africa BelizeIceland Jordan Swaziland MontserratLuxembourg Kuwait Tanzania Netherlands AntillesMonaco Lebanon Uganda Puerto RicoNetherlands Oman Zambia El SalvadorNorway Qatar  Zimbabwe GuatemalaSweden Saudi Arabia South Asia HondurasSwitzerland Syria Afghanistan MexicoSouth Europe Turkey Bangladesh NicaraguaAlbania United Arab Emirates India PanamaAzores Yemen Nepal South AmericaBosnia-Hercegovina North Africa Pakistan ArgentinaCroatia Algeria Sri Lanka BoliviaCyprus Cape Verde Northeast Asia BrazilGibraltar Egypt China ChileGreece Libya Hong Kong ColombiaItaly Morocco Japan EcuadorMacedonia Sudan Korea, South GuyanaMadeira, Portugal Tunisia Macao ParaguayMalta Central & West Africa Mongolia PeruPortugal Africa Other Taiwan SurinamSlovenia Burkina Faso, UpperVolta Tibet UruguaySpain Cameroon Southeast Asia VenezuelaYugoslavia Chad Brunei OceaniaEastern Europe Congo Burma American SamoaBulgaria Gambia Indonesia AustraliaCzechoslovakia Ghana Kampuchea FijiCzeck Republic Guinea Laos French PolynesiaHungary Ivory Coast Malaysia New ZealandPoland Liberia Philippines Papua New GuineaRomania Mali Singapore SolomonsSlovakia Nigeria Thailand TongaFormer USSR Senegal Viet Nam Western SamoaArmenia Sierra Leone North AmericaAzerbaijan Togo CanadaBelarus Zaire United StatesEstonia Southeast Africa CaribbeanGeorgia Angola AntiguaKazakhstan Botswana BahamasKirgyzstan Burundi Barbados48I.3 Conditions of landing imposedThe categories of conditions of landing imposed that are used by CIC were aggregated into threegroups. These are shown in Table I.3.Table I.3 Aggregation of condition categoriesCondition Groups Condition CategoriesNo medical conditions Missing, 00Medical conditions 32-35, 42, 46Other conditions OtherI.4 Medical profile assessmentImmigrants may have two Medical Profile Assessments. If immigrants’ assessment category was2-7 on either of the two assessments, immigrants were classed as having a ‘medical condition’.Categories 2-7 all have a medical condition but vary in the degree to which they pose a publichealth risk or their need for medical services. For the purposes of this report, the results from thetwo assessments were combined. If the assessment category was 0, 1 or missing on bothassessments, immigrants were classified as having no medical condition.I.5 DiagnosesDiagnoses on the hospital discharge and physician files were coded according to the InternationalClassification of Diseases, 9th Revision (ICD-9). For the purposes of this pilot study the codeswere aggregated into the thirteen Chapter levels. The codes that comprise each chapter are shownin Table I.4.Table I.4 Diagnostic codes, International Classification of Diseases, 9th R vi ion1Abbreviation ICD Chapter Heading ICD CodesInfectious Infectious and parasitic diseases 001-139Neoplasms Neoplasms 140-239Endocrine Endocrine, nutritional and metabolic diseases, and immunity disorders240-279Blood Diseases of blood and blood-forming organs 280-289Mental Mental disorders 290-319Nervous, sens Diseases of the nervous system and sense organs 320-389Circulatory Diseases of the circulatory system 390-459Respiratory Diseases of the respiratory system 460-519Digestive Diseases of the digestive system 520-579Genitourinary Diseases of the genitourinary system 580-629Pregnancy Complications of pregnancy, childbirth, and the puerperium 630-676Skin Diseases of the skin and subcutaneous tissue 680-709Musculoskeletal Diseases of the musculoskeletal system and connective tissue 710-739Congenital Congenital anomalies 740-759Perinatal Certain conditions originating in the perinatal period 760-779Ill-defined Symptoms, signs, and ill-defined conditions 780-799Injuries, poison Injury and poisoning 800-999V codes Influencing health status and contact with health services V01-V821. Used in both Manitoba and British Columbia49I.6 ProceduresManitoba and British Columbia used different classification schemes to code the procedures thatwere performed in-hospital. These are shown in Tables I.6 and I.7 respectively. In reportingprocedures in this report only the broad chapter categories were used.Table I.6 Procedure codes, International Classification of Diseases, 9th Revi ion1Abbreviation Chapter Heading CodesNervous Operations on the nervous system 1-5Endocrine Operations on the endocrine system 6-7Eye Operations on the eyes 8-16Ear Operations on the ears 18-20Nose, mouth, ph Operations on the nose, mouth, and pharynx 21-29Respiratory Operations on the respiratory system 30-34Cardiovascular Operations on the cardiovascular system 35-39Hemic, lymph Operations on the hemic and lymphatic systems 40-41Digestive Operations on the digestive system 42-54Urinary Operations on the urinary system 55-59Genital, male Operations on the male genital organs 60-64Genital, female Operations on the female genital organs 65-71Obstetrical Obstetrical procedures 72-75Musculoskeletal Operations on the musculoskeletal system 76-84Integumentary Operations on the integumentary system 85-86Diag, therapeut Miscellaneous diagnostic and therapeutic procedures 87-991. Used in ManitobaTable I.7 Procedure codes, Canadian Classification of Diagnostic, Therapeutic, and SurgicalProcedures1Abbreviation Chapter Heading CodesDiag, therapeut Certain Diagnostic and Therapeutic Procedures 01-13Nervous Operations on the nervous system 14-18Endocrine Operations on the endocrine system 19-20Eye Operations on the eyes 21-29Ear Operations on the ears 30-32Nose, mouth, phOperations on the nose, mouth, and pharynx 33-41Respiratory Operations on the respiratory system 42-46Cardiovascular Operations on the cardiovascular system 47-51Hemic, lymph Operations on the hemic and lymphatic systems 52-53Digestive Operations on the digestive system and abdominal region 54-66Urinary Operations on the urinary tract 67-71Genital, male Operations on the male genital organs 72-76Genital, female Operations on the female genital organs 77-83Obstetrical Obstetric procedures 84-87Musculoskeletal Operations on the musculoskeletal system 88-96Breast Operations on the breast 97Skin, subcutan Operations on skin and subcutaneous tissue 98Other Procedures not classified elsewhere 991. Used in British Columbia

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